(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "North Carolina Register v.4 no. 13 (10/2/1989)"

eJ W fcFU/' ! .fa/WJ 



I 






83 



r^ 



; 



NORTH CAROLINA 

REGISTER 



IN THIS ISSUE 



FINAL DECISION LETTERS 



PROPOSED RULES 



B 



ft. 



jTITU| 

iIyk 



Elections 

EHNR 

Human Resources 

Insurance 

Medical Examiners 

j 

FINAL RULES 



List of Rules Codified 



ISSUE DATE: OCTOBER 2, 1 989 



Volume 4 • Issue 13 • Pages 659-712 



INFORMATION ABOUT THE NORTH CAROLINA REGISTER AND ADMINISTRATIVE CODE 



NORTH CAROLINA REGISTER 

The North Carolina Register is published bi-monthly 
and contains information relating to agency, executive, 
legislative and judicial actions required by or affecting 
Chapter 150B of the General Statutes. All proposed, ad- 
ministrative rules and amendments filed under Chapter 
150B must be published in the Register. The Register 
will typically comprise approximately fifty pages per 
issue of legal text. 

State law requires that a copy of each issue be pro- 
vided free of charge to each county in the state and to 
various state officials and institutions. The North Carolina 
Register is available by yearly subscription at a cost of 
one hundred and five dollars ($105.00) for 24 issues. 

Requests for subscriptions to the North Carolina 
Register should be directed to the Office of Ad- 
ministrative Hearings, P. O. Drawer 1 1666, Raleigh, N. 
C. 27604, Attn: Subscriptions. 

ADOPTION, AMENDMENT, AND REPEAL OF 
RULES 

An agency intending to adopt, amend, or repeal a rule 
must first publish notice of the proposed action in the 
North Carolina Register. The notice must include the 
time and place of the public hearing; a statement of how- 
public comments may be submitted to the agency either 
at the hearing or otherwise; the text of the proposed 
rule or amendment; a reference to the Statutory 
Authority for the action and the proposed effective date. 

The Director of the Office of Administrative Hearings 
has authority to publish a summary, rather than the 
full text, of any amendment which is considered to be 
too lengthy. In such case, the full text of the rule con- 
taining the proposed amendment will be available for 
public inspection at the Rules Division of the Office of 
Administrative Hearings and at the office of the pro- 
mulgating agency. 

Unless a specific statute provides otherwise, at least 
30 days must elapse following publication of the pro- 
posal in the North Carolina Register before the agency 
may conduct the required public hearing and take ac- 
tion on the proposed adoption, amendment or repeal. 

When final action is taken, the promulgating agency 
must file any adopted or amended rule for approval by 
the Administrative Rules Review Commission. Upon ap- 
proval of ARRC, the adopted or amended rule must be 
filed with the Office of Administrative Hearings. If it 
differs substantially from the proposed form published 
as part of the public notice, upon request by the agen- 
cy, the adopted version will again be published in the 
North Carolina Register. 

A rule, or amended rule cannot become effective 
earlier than the first day of the second calendar month 
after the adoption is filed with the Office of Ad- 
ministrative Hearings for publication in the NCAC. 

Proposed action on rules may be withdrawn by the 
promulgating agency at any time before final action is 
taken by the agency. 

TEMPORARY RULES 

Under certain conditions of an emergency nature, 
some agencies may issue temporary rules. A temporary 
rule becomes effective when adopted and remains in 



effect for the period specified in the rule or 180 days, 
whichever is less. An agency adopting a temporary rule 
must begin normal rule-making procedures on the per-l 
manent rule at the same time the temporary rule is 
adopted. 

NORTH CAROLINA ADMINISTRATIVE CODE 

The North Carolina Administrative Code (NCAC) is 
a compilation and index of the administrative rules of 
25 state agencies and 38 occupational licensing boards. 
The NCAC comprises approximately 15,000 letter size, 
single spaced pages of material of which approximate- 
ly 35% is changed annuallv. Compilation and publica- 
tion of the NCAC is mandated by G.S. 150B-63(b). 

The Code is divided into Titles and Chapters. Each . 
state agency is assigned a separate title which is fur- 
ther broken down by chapters. Title 21 is designated 
for occupational licensing boards. 

The NCAC is available in two formats. 

(1) Single pages may be obtained at a minimum 
cost of two dollars and 50 cents ($2.50) for 10 
pages or less, plus fifteen cents ($0.15) per each 
additional page. 

(2) The full publication consists of 52 volumes, 
totaling in excess of 15,000 pages. It is sup- 
plemented monthly with replacement pages. A 
one year subscription to the full publication in- 
cluding supplements can be purchased for 
seven hundred and fifty dollars ($750.00). In- 
dividual volumes may also be purchased with 
supplement service. Renewal subscriptions for 
supplements to the initial publication available. 

Requests for pages of rules or volumes of the NCAC 
should be directed to the Office of Administrative 
Hearings. 

NOTE 

The foregoing is a generalized statement of the pro- 
cedures to be followed. For specific statutory language, 
it is suggested that Articles 2 and 5 of Chapter 150B of 
the General Statutes be examined carefully. 

CITATION TO THE NORTH CAROLINA 
REGISTER 

The North Carolina Register is cited bv volume, issue, 
page number and date. 1:1 NCR 101-201, April 1, 1986 

refers to Volume 1, Issue 1, pages 101 through 201 of 
the North Carolina Register issued on April 1, 1986. 



North Carolina Register. Published bi-monthly by 
the Office of Administrative Hearings, P.O. Drawer 
11666, Raleigh, North Carolina 27604, pursuant to 
Chapter 150B of the General Statutes. Subscriptions 
one hundred and five dollars ($105.00) per year. 
North Carolina Administrative Code. Published 
in looseleaf notebooks with supplement service by 
the Office of Administrative Hearings, P.O. 
Drawer 1 1666, Raleigh, North Carolina 27604, pur- 
suant to Chapter 150B of the General Satutes. 
Subscriptions seven hundred and fifty dollars 
(S750.00). Individual volumes available. 



NORTH 
CAROLINA 
REGISTER 



ISSUE CONTENTS 




Office of Administrative Hearings 

P. O. Drawer 11666 

Raleigh, ,VC 27604 

(919) 733-2678 



James R. Scarcella Sr., 

Deputy Director 
Molly Masich, 

Director APA Services 



Staff: 

Ruby Creech, 

Publications Coordinator 
Teresa Kilpatrick, 

Editorial Assistant 
Jean Shirley, 

Editorial Assistant 



I. FINAL DECISION LETTERS 

Voting Rights Act 659 

II. PROPOSED RULES 
Elections 

Departmental Rules 661 

EHNR 

Environmental Management.... 700 

Wildlife Resources 

Commission 700 

Human Resources 

Health Services 661 

Mental Health, Mental 
Retardation and Substance 

Abuse Services 685 

Insurance 

Fire and Casualty Division 689 

Life: Accident and Health 690 

Licensing Board 

Medical Examiners 701 

III. FINAL RULES 

List of Rules Codified 704 

IV. CUMULATIVE F\DEX 710 



NOR III CAROLINA REGISTER 

Publication Deadlines and Schedules 

(January 1989 - May 1990) 



Issue 
Date 



+*+++*++ 

01/02/89 
01/16/89 
02/01/89 
02/15/89 
03/01/89 
03/15/89 
04/03/89 
04/14/89 
05/01/89 
05/15/89 
06/01/89 
06/15,89 
07/03,89 
07/14/89 
08/01/89 
08,15,89 
09/01/89 
09/15 89 
10/02/89 
10/16/89 
11/01/89 
11/15/89 
12/01/89 
12/15/89 
01/02/90 
01/16/90 
02/01/90 
02/15/90 
03/01/90 
03/15/90 
04/02/90 
04/16/90 
05/01/90 
05/15/90 



Last Day 

for 
Filing 



+*+++**+ 

12/08/88 
12/27/88 
01/10/89 
01/26/89 
02/08/89 
02/21/89 
03/10/89 
03/23/89 
04/10/89 
04/24/89 
05/10/89 
05/24/89 
06/12/89 

06 22/89 

07 11 89 

07 25/89 
OS 1 1 89 

08 ; 24/89 
09/11/89 
09/25/89 
10/11/89 
10/24/89 
11/07/89 
11/22/89 
12/07/89 
12/20/89 
01/10/90 
01/25/90 
02/08/90 
02/22/90 
03/12/90 
03/23/90 
04/09/90 
04/24/90 



I^st Day 
for 

Electronic 
Filing 



12/15/88 
01/03/89 
01/17/89 
02/02/89 
02/15/89 
03/02/89 
03/17/89 
03/31/89 
04/17/89 
05/01/89 
05/17/89 
06/01/89 
06/19/89 
06/29/89 
07/18/89 
08/01/89 
08/18/89 
08/31/89 
09/18/89 
10/02'89 
10/18/89 
10/31/89 
11/15/89 
12/01/89 
12/14/89 
12/29/89 
01/18/90 
02/01/90 
02/15/90 
03/01/90 
03/19/90 
03/30/90 
04/17/90 
05/01/90 



Farliest 
Date for 
Public 
I learing & 
Adoption by 
Agency 

+*++++** 

02/01/89 
02/15/89 
03/03/89 
03/17/89 
03/31/89 
04/14/89 
05/03/89 
05/14/89 
05/31/89 
06/14/89 
07/01/89 
07/15/89 
08/01/89 
08, 13 89 
OX 31 SQ 
09/14/89 
10/01/89 
10,15/89 
11/01/89 
11/15/89 
12/01/89 
12/15/89 
12/31/89 
01/14/90 
02/01/90 
02/15/90 
03/03/90 
03/17/90 
03/31/90 
04/14/90 
05,02/90 
05/16/90 
05/31/90 
06/14/90 



Farliest 

Effective 

Date 



******** 

05/01/89 
05/01/89 
06/01/89 
06/01/89 
07/01/89 
07/01/89 
08/01/89 
08/01/89 
09/01/89 
09/01/89 
10/01/89 
10/01/89 
11/01/89 
11/01/89 
12/01/89 
12,01/89 
01/01/90 
01/01/90 
02/01/90 
02/01/90 
03/01/90 
03/01/90 
04/01/90 
04/01/90 
05/01/90 
05/01/90 
06/01/90 
06/01/90 
07/01/90 
07/01/90 
08/01/90 
08/01/90 
09/01/90 
09/01/90 



* The "Earliest Effective Date" is computed assuming that the public hearing 
and adoption occur in the calendar month immediately following the "Issue 
Date", that the agency files the rule with The Administrative Rules Review 
Commission by the 20th of the same calendar month and that ARRC approves 
the rule at the next calendar month meeting. 



T 



VOTING RIGHTS ACT FINAL DECISION LETTERS 



[G.S. 120-30.9H, effective July 16, 1986, requires that all letters and other documents issued by the 
Attorney General of the United States in which a final decision is made concerning a "change af- 
fecting voting" under Section 5 of the Voting Rights Act of 1965 be published in the North Carolina 
Register. / 



U.S. Department of Justice 
Civil Rights Division 

JPT:MAP:RA:gmh 

DJ 166-012-3 Voting Section 

Y8580 P.O. Box 66128 

Z1757-1759 Washington, D.C. 20035-6128 

September 8, 1989 

DeWitt F. McCarley, Esq. 

City Attorney 

P.O. Box 7207 

Greenville, North Carolina 27835-7207 

Dear Mr. McCarley: 

This refers to the three annexations [Ordinance Nos. 1972, 1973, and 1991 (1989)| and the desig- 
nation of the annexed areas to single-member districts for the City of Greenville in Pitt County, North 
Carolina, submitted to the Attorney General pursuant to Section 5 of the Voting Rights Act of 1965, 
as amended, 42 L'.S.C. 1973c. We received your submission on July 10, 1989. 

The Attorney General does not interpose any objections to the changes in question. However, 
we feel a responsibility to point out that Section 5 of the Voting Rights Act expressly provides that the 
failure of the Attorney General to object does not bar any subsequent judicial action to enjoin the 
enforcement of such changes. See the Procedures for the Administration of Section 5 (28 C.F.R. 
51.41). 

Sincerely, 






1 



James P. Turner 

Acting Assistant Attorney General 

Civil Rights Division 



By: 



Barry H. Weinberg 
Acting Chief, Voting Section 



NOR TH CAROLINA REGIS TER 659 



VOTING RIGHTS ACT FINAL DECISION LETTERS 



' 



L'.S. Department of Justice 
Civil Rights Division 



JPT:MAP:CM:rac:gmh 

DJ 166-012-3 Voting Section 

Y9449-9458 P.O. Box 66128 

Washington, D.C. 20035-6128 



September 11, 14X4 



Robert C. Cogswell. Jr., Esq. 
City Attorney 
P.O. Box 1513 

Favetteville, North Carolina 28302-1513 



Dear Mr. Cogswell: 



This refers to the nine annexations (Ordinance Nos. 88-11-315. 88-11-316, 88-11-317, 88-11-318, 
89-2-319, 89-3-320, 89-4-321, 89-4-322, 89-5-323) and the designation of the annexed areas to single- 
member districts for the City of Favetteville in Cumberland County. North Carolina, submitted to the 
Attorney General pursuant to Section 5 of the Voting Rights Act of 1965. as amended, 42 U.S.C. 
1973c. We received vour initial submission on Julv 1 1, 1989; supplemental information was received 
on August 31, L989. ' 

The Attorney General does not interpose any objections to the changes in question. However, 
we feel a responsibility to point out that Section 5 of the Voting Rights Act expressly provides that the 
failure of the Attorney General to object does not bar any subsequent judicial action to enjoin the 
enforcement of such changes. In addition, as authorized by Section 5, the Attorney General reserves 
the right to reexamine this submission if additional information that would otherwise require an ob- 
jection comes to his attention during the remainder of the sixty-day review period. See the Procedures 
for the Administration of Section 5?28 C.F.R. 51.41 and 51.43). 

Sincerely, 

James P. Turner 

Acting Assistant Attorney General 

Civil Rights Division 



Bv: 



Barry H. Weinberg 
Acting Chief, Voting Section 



c 



660 NOR TH CAROLINA REGIS TER 



PROPOSED RULES 



TITLE 8 STATE BOARD OF ELECTIONS 

1\ otice is hereby given in accordance with G.S. 
1 SOB- 12 that the Stale Board of Elections intends 
to amend rule(s) cited as 8 NCAC I .0004. 

1 he proposed effective date of this action is 
February I, 1990. 

1 he public hearing will be conducted at 1 1:00 
a.m. on November I, 1989 at Conference Room 
812, State Board of Elections, Raleigh Building, 
5 West Hargett Street, Raleigh, North Carolina 
27601. 

(comment Procedures: Any person interested in 
this amendment may present written or oral com- 
ments at the public hearing. Written statements 
not presented at the public hearing should be di- 
rected to the State Board of Elections during the 
30- day period prior to the scheduled public hear- 
ing at the following address: 

State Board of Elections 

P.O. Box 1166 

Raleigh, NC 27602 

CHAPTER I - DEPARTMENTAL RULES 

.0004 PROCEDURES FOR POLITICAL 
COMMITTEES 

(d) Whenever a political committee or referen- 
dum committee shall fail to file with the State 
Board of Flections any report required to be filed 
under the provisions of G.S. 163-278.9 or G.S. 
1 63-278. QA, the Board, bv certified mail, shall 
issue a formal NOTICE OF NONCOMPLI- 
ANCE to the political treasurer of said commit- 
tee and shall order that the report be filed 
immediately. In the event said committee does 
not file its report within 20 days of the issuance 
of the NOTICE OE NONCOMPLIANCE, the 
Board, bv certified mail, shall issue NOTICE OF 
TERMINATION OE ACTIVE STATUS, 
which shall render said committee ineligible to 
receive or make contributions until such time as 
it has filed the delinquent report and has satisfied 
any statutory penalty incurred as a result of 
noncompliance with the provisions of Article 
22 A of Chapter 163. 

Statutory Authority G.S. 163-278.7; 163-278.8; 
163-278.21; 163-278.22; 163-278.23; 163-278.27. 

TITLE 10 - DEPARTMENT OF HUMAN 
RESOURCES 



iV otice is hereby given in accordance with G.S. 
I SOB- 12 that the Commission for Health Sendees 
intends to amend rule(s) cited as 10 NCAC 4C 
.0302 - .0303; 10 NCAC 7 A .0/06 - .0107, .0209, 
.0405; 10 NCAC 7C .0204 - .0205, .0601 - .0602; 
.0303; 10 NCAC 8 A .1202; 
.0116, .0902, .0904, .0906; 
10 NCAC 9D .0309, .0317; 
0444; intends to repeal 



10 NCAC 7G .0302 
10 NCAC 8B .0110 
10 NCAC 8C .1106; 
10 NCAC 10 A .0443 



rule(s) cited as 10 NCAC 7C .0603; and intends 
to adopt rule(s) cited as 10 NCAC 7 A .0504; 10 
NCAC 7C .0604 - .0608; 10 NCAC 10 A .2501 - 
.2508; 10 NCAC 10G .1001 - .1008. 

1 he proposed effective date of this action is 
February I, 1990. 

1 he public hearing will be conducted at: 

November 1, 1989 

7:00 p.m. 

Town Hall 224 North Trade Street 

Matthews, N.C. 

November 6. 1989 

1:30 p.m. 

Archdale Building 

Hearing Room (Ground Floor) 

512 North Salisbury Street 

Raleigh, North Carolina 

(^ omment Procedures: Any person may request 
information or copies of the proposed rules by 
writing or calling John P. Barkley, Agency Legal 
Specialist, Department of Environment, Health, 
and Natural Resources. P.O. Box 27687, Raleigh, 
North Carolina 27611-7687, (919) 733-3134. 
Written comments on these rule changes may be 
sent to Mr. Barkley at the above address. Written 
and oral comments (no more than ten minutes for 
oral comments) on these rule changes may be 
presented at the public hearing. Notice should be 
given to Mr. Barkley at least three days prior to 
the public hearing if you desire to speak. 

CHAPTER 4 - HEALTH SERVICES: OFFICE OF 
THE DIRECTOR 

SUBCHAPTER 4C - PAYMENT PROGRAMS 

SECTION .0300 - ELIGIBILITY PROCEDURES 

.0302 AUTHORIZATIONS AND CLAIMS 
PROCESSING LIME FRAMES 

The following time frames shall apply to all 
payment programs: 
(6) A claim must show payments by other third 
party payors or it must show that all other 



NORTH CAROLINA REGISTER 



661 



PROPOSED RULES 



payors have denied payment or that there 
are no other payors. Once another payor 
has been billed, if no response has been re- 
ceived within SO days after the date of ser- 
vice, the provider may bill the division. 
Department, but the claim must indicate 
that the other payor has been billed and no 
response has been received. If payment is 
received later from the other payor, the pro- 
vider must refund the division. Department. 
Providers of pharmacy outpatient services 
are required to bill Medicaid. 1 Iowever, 
thev are not required to bill other third party 
payors and wait SO days before billing the 
division Department but are required to re- 
fund the division Department if other third 
party payments are received. 

Statutory Authority G.S. 130.4-5(3); BOA- 124; 
130A-127; 130.4-129; /30A-J77; I30A-205. 

.0303 PAYMENT LIMITATIONS 

(d) If prior to the division's Department's 
payment for particular services or appliances, the 
provider, the patient, or a person responsible for 
the patient receives partial or total payment for 
the services or appliances from a third party 
payor, or receives funds in settlement of a civil 
claim fof bodily injury which are available to pay 
for the services or appliances, the division De- 
partment may pay only the amount, if any. by 
which the division's Department's payment rate 
exceeds the amount received by the person. For 
the purpose of this Rule, the division's Depart- 
ment's payment rate means the rate of re- 
imbursement established in 10 NCAC AC .0400 
and 10 NCAC SA .0400. 

Statutory Authority G.S. 130A-5(3); I30A-124; 
130A-I27; 130A-I29; I30A-I77; 130.4-205. 

CHAPTER 7 - HEALTH: EPIDEMIOLOGY 

SUBCHAPTER 7 A - ACUTE COMMUNICABLE 
DISEASE CCNTROL 

SECTION .0100 - REPORTING OF 
COMMUNICABLE DISEASES 

.0106 REPORTABLE DISEASES AND 
CONDITIONS 

(a) The following named diseases and condi- 
tions are declared to be dangerous to the public 
health and are hereby made reportable within the 
time period specified after the disease or condi- 
tion is reasonably suspected to exist: 

( 1 ) acquired immune deficiency syndrome 
(AIDS) - "days: 

(2) amebiasis - 7 days; 



(3 1 
(4) 
(5) 
(6) 
(7) 
(8) 
(9) 

(10) 

(11) 
(12) 
(13) 
(14) 



(15) 

(16) 
(17) 

(18) 
(19) 
(20) 
(21) 



(23) 
(24) 
(25) 
(26) 
(27) 

(28) 
[29) 

(30) 
(31) 

(321 
(33 



anthrax - 24 hours; 

blastomycosis - 7 days; 

botulism - 24 hours; 

brucellosis - 7 days; 

Campylobacter infection - 24 hours; 

chancroid - 24 hours; 

chlamydial infection (laboratory con- 
firmed) - 7 days; 

cholera - 24 hours; 

dengue - 7 days; 

diptheria - 24 hours; 

encephalitis - 7 days; 

foodborne disease, including but not 
limited to Clostridium perfringens, 
staphylococcal, and Bacillus cereus - 24 
hours; 

gonorrhea - 24 hours; 

granuloma inguinale - 24 hours; 

Hemophilus influenzae, invasive disease 
- 24 hours; 

hepatitis A - 24 hours: 

hepatitis B - 24 hours; 

hepatitis B carriage - 7 days; 

hepatitis non-A. non-B - 7 days; 

human immunodeficiency virus infection 
[HIV] confirmed - 7 davs; 
(-34+ legionellosis - 7 days: 
(44+ leprosy - 7 days; 
f44+ leptospirosis - 7 days; 



( 



(44+ 

davs; 

(44+ 

(44} 

( 1 Q \ 
\ -' , ' / 

f44+ 
f44+ 



Lyme disease - 7 days; 

ymphogranuloma venereum - 7 



1H> 

(35) 

(36j 
(37) 
[38} 

(39) 
(40) 
(41) 
(42) 

(43) 
(44) 

(45) 
(46) 
(47) 
(48) 
(49) 
(50) 



malaria - 7 days; 

measles (rubeola) - 24 hours; 

meningitis, pneumococcal - 7 days; 

meningitis, viral (aseptic) - 7 days; 

meningococcal disease - 24 hours; 
mucocutaneous lymph node syn- 
drome (Kawasaki syndrome) 
(44+ mumps - 7 days: 
(44) nongonococcal urethritis 
(44+ plague - 24 hours; 
(44) paralytic poliomyelitis - 24 hours; 
(44) psittacosis - 7 days; 

Q fever - 7 days; 

rabies, human - 24 hours; 

Reyes syndrome - 7 days; 
Rocky Mountain spotted fever - 7 



7 days; 
7 davs; 



(49) 



(-44+ 
davs; 
(44+ 
(44+ 
davs; 
(44+ 
(44+ 

(44+ 

\ T I » J 

4+4+ 



rubella - 24 hours; 
rubella congenital 



svndrome - 7 



salmonellosis - 24 hours; 

shigellosis - 24 hours; 

syphilis - 24 hours; 

tetanus - 7 days; 

toxic shock syndrome - 7 days; 

trichinosis - 7 davs; 



c 



662 



SORTH CAROLINA REGISTER 



PROPOSED RULES 



(51) £50} tuberculosis - 24 hours; 

(52) (-$4-} tularemia - 24 hours; 

(53) f54+ typhoid - 24 hours; 

(54) f54f typhoid carriage (Salmonella typhi) 
- 7 days; 

(55) (44+ typhus, epidemic (louse-borne) - 7 
days; 

(56) (44f whooping cough - 24 hours; 

(57) f-5**f yellow fever - 7 days. 

(b) 1 or purposes of reporting confirmed hu- 
man immunodeficiency virus infection (HIV) is 
defined as a positive virus culture; repeatedly re- 
active DA antibody test confirmed by western 
blot or indirect immunofluorcscent antibody test; 
or other confirmed testing method approved by 
the Director of the State Public Health 1 ahora- 
torv conducted on or after February L 199Q. 

Slaluton Authority G.S. I30A-134; I30A-I41. 

.0107 METHOD OF RKPORTING 

(a) When a report of a disease or condition is 
required to be made pursuant to G.S. 130A-135 
through 139 and 10 NCAC 7A .0106, the report 
shall be made to the local health director as fol- 
lows: 

(3) Reports of cases of confirmed HIV in- 
fection identified bv anonymous tests that 
are conducted at HIV testing sites desig- 



nated bv the State Health Director pursu- 
ant to 10 NCAC 7A .()20')(d)(14) shall be 
made on forms provided bv the Division 
for that purpose. No communicable dis- 
ease report card shall be required. Divi- 
sion of I lealth Services and shall include 
the name and address of the patient, the 
name and address of any minor's parent 
or guardian, and all other pertinent 
epidemiologic information requested on 
the form. 

(4)frH In addition to the requirements of Par- 
agraph (1) and (2), the epidemiologic in- 
formation requested on a surveillance 
form provided by the Division of Health 
Services shall be completed and submitted 
for the reportable diseases and conditions 
identified in 10 NCAC 7A .0106 (1), (6), 
(17), (IS), (19), (20). (21), (22), (23), (24), 
(25), (27), (29), (31), (32), (36), (37). (40), 
(41), (43), (47), (48), (49), (50), (51), (52), 
(55). 

(5)f4f Communicable disease report cards and 
surveillance forms are available from the 
morbidity unit, N.C. Division of Health 
Services, P.O. Box 2091, Raleigh, N.C. 
27602, and from local health departments. 

Statutory Authority G.S. 130A-134; 130A-I4I. 



SECTION .0200 - CONTROL MEASURES FOR 
COMMUNICABLE DISEASES 

.0209 CONTROL MEASURES 

(a) Except as provided in Paragraph ftty? Para- 
graphs (d) and (i), the specific control measures 
for each disease and condition shall be those 
specified by the American Public Health Associ- 
ation in its publication, Control of 
Communicable Disease in Man. Control of 
Communicable Disease in Man is hereby 
adopted by reference in accordance with G.S. 
150B- 14(c). Copies of this publication are 
available from the American Public Health As- 
sociation, Department JE, 1015 15th Street, 
N.W., Washington, DC 20005. A copy is 
available for inspection in the Communicable 
Disease Control Branch, Cooper Memorial 
Health Building, 225 N. McDowell Street, 
Raleigh, North Carolina 27602. 

(d) The following are the control measures for 
the Acquired Immune Deficiency Syndrome 
(AIDS) and Human Immunodeficiency Virus 
(HIV) infection: 

(1) Infected persons shall: 

(A) refrain from sexual intercourse unless 
condoms are used; exercise caution when 
using condoms due to possible condom 
failure; 

(B) never share needles or syringes; 

(C) not donate or sell blood, plasma, 
platelets, other blood products, semen, 
ova, tissues, organs, or breast milk; 

(D) have a skin test for tuberculosis; 

(E) notify future sexual intercourse partners 
of the infection; if the time of initial in- 
fection is known, notify persons who have 
been sexual intercourse and needle part- 
ners since the date of infection; and, if the 
date of initial infection is unknown, notify 
persons who have been sexual intercourse 
and needle partners for the previous year. 

(2) The attending physician shall: 

(A) give the control measures in (d) (1) to 
infected patients, in accordance with 10 
NCAC 7A .0210; 

(B) give the patient a form provided by the 
Division of Health Services and encourage 
its use for listing partners for whom no- 
tification is required in (d)(1)(E); the 
physician shall encourage the patient to 
arrange an appointment with a Division 
of Health Services AIDS counselor re- 
garding partner notification and to com- 
plete the form, and either take it to the 
Division of Health Services AIDS coun- 
selor or mail it to the division so that the 



NORTH CAROLINA REGISTER 



663 



PROPOSED RULES 



division may undertake counseling of the 
partners to prevent further transmission. 
The Division of I lealth Services shall de- 
stroy the list after it has counseled the 
partners or after a reasonable attempt has 
been made to do so; 

(C) If the attending physician knows the 
identity of the spouse of an HIV-infected 
patient and has not, with the consent of 
the infected patient, notified and coun- 
seled the spouse appropriately, the physi- 
cian shall list the spouse on a form 
provided by the Division of Health Ser- 
vices and shall mail the form to the Divi- 
sion; the Division will undertake to 
counsel the spouse; the attending physi- 
cian's responsibility to notify exposed and 
potentially exposed persons is satisfied by 
fulfilling the requirements of (d)(2)(B) and 
(C); 

(D) advise infected persons concerning 
proper clean-up of blood and other body 
fluids; 

(Li) advise infected persons concerning the 
risk of perinatal transmission and trans- 
mission by breastfeeding. 
(3) The attending physician of a child who 
is infected with HIV and who may pose a 
significant risk of transmission in the 
school or day care setting because of 
open, oozing wounds or because of be- 
havioral abnormalities such as biting shall 
notify the local health director. The local 
health director shall consult with the at- 
tending physician and investigate the cir- 
cumstances. 
(A) If the child is in school or scheduled for 
admission and the local health director 
determines that there may be a significant 
risk of transmission, the local health di- 
rector shall consult with an interdiscipli- 
nary committee, which shall include 
appropriate school personnel, a medical 
expert, and the child's parent or guardian 
to assist in the investigation and determi- 
nation of risk. The local health director 
shall notify the superintendent or private 
school director of the need to appoint 
such an interdisciplinary committee. 
(i) If the superintendent or private school 
director establishes such a committee 
within three days of notification, the 
local health director shall consult with 
this committee, 
(ii) If the superintendent or private 
school director does not establish such 
a committee within three days of no- 



tification, the local health director shall 
establish such a committee. 

(B) If the child is in school or scheduled for 
admission and the local health director 
determines, after consultation with the 
committee, that a significant risk of trans- 
mission exists, the local health director 
shall: 

(i) notify the parents; 

(ii) notify the committee; 

(iii) assist the committee in determining 
whether an adjustment can be made to 
the student's school program to elimi- 
nate significant risks of transmission; 

(iv) determine if an alternative educa- 
tional setting is necessary to protect the 
public health; 

(v) instruct the superintendent or private 
school director concerning appropriate 
protective measures to be implemented 
in the alternative educational setting 
developed by appropriate school per- 
sonnel; and 

(vi) consult with the superintendent or 
private school director to determine 
which school personnel directly in- 
volved with the child need to be notified 
of the HIV infection in order to prevent 
transmission and ensure that these per- 
sons are instructed regarding the neces- 
sity for protecting confidentiality. 

(C) If the child is in day care and the local 
health director determines that there is a 
significant risk of transmission, the local 
health director shall notify the parents that 
the child must be placed in an alternate 
child care setting that eliminates the sig- 
nificant risk of transmission. 

(4) When health care workers or other per- 
sons have had a nonsexual blood or body 
fluid exposure that poses a significant risk 
of transmission, the following shall apply: 
(A) When the source person is known: 
(i) The attending physician or occupa- 
tional health care provider responsible 
for the exposed person shall notify the 
attending physician of the person whose 
blood or body fluids is the source of the 
exposure that an exposure has occurred. 
If the attending physician of the source 
person knows the source's HIV in- 
fection status, the physician shall trans- 
mit this information to the attending 
physician of the exposed person. If the 
attending physician of the source per- 
son does not know the infection status 
of the source person, the physician shall 
discuss the exposure with the source 



664 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



and if the source person is at high risk 
for 1 1 IV infection, shall request permis- 
sion for testing for HIV infection. If 
permission is granted, the source shall 
be tested. If permission is denied, the 
local health director may order testing 
of the source if the local health director 
determines that the exposure poses a 
significant risk of transmission of 1 1 IV 
and that the source is at high risk for 
HIV infection. Whether or not the 
source is tested, the attending physician 
of the exposed person shall be notified 
of the risk status of the source and the 
infection status of the source, if known. 
(B) When the source person is unknown, 
the attending physician of the exposed 
person shall inform the exposed person 
of the risk of transmission and offer test- 
ing for HIV infection as soon as possible 
after exposure and at reasonable intervals 
up to one year to determine whether 
transmission occurred. 

(5) The attending physician shall notify the 
local health director when the physician, 
in good faith, has reasonable cause to 
suspect a patient infected with HIV is not 
following or cannot follow control meas- 
ures and is thereby causing a significant 
risk of transmission. 

(6) When the local health director is notified 
pursuant to Paragraph (5) of a person 
who is mentally ill or mentally retarded, 
the local health director shall confer with 
the attending mental health physician or 
appropriate mental health authority and 
the physician who notified the local health 
director to develop an appropriate plan to 
prevent transmission. 

(7) The Director of Health Services of the 
North Carolina Department of Correction 
and the prison facility administrator shall 
be notified by the attending physician of 
any HIV-infected person confined in a 
state prison. If the prison facility admin- 
istrator, in consultation with the Director 
of Health Services, determines that a con- 
fined HIV-infected person is not following 
or cannot follow prescribed control meas- 
ures, thereby presenting a significant risk 
of HIV transmission, the administrator 
and the director shall develop and imple- 
ment jointly a plan to prevent trans- 
mission, including making appropriate 
recommendations to the unit housing 
classification committee. 

(8) The local health director shall ensure that 
the health plan for local jails include edu- 



m 



cation of jail staff and prisoners about 
HIV, how it is transmitted, and how to 
avoid acquiring or transmitting this in- 
fection. 

I Icalth eafe workers, including emergency 
rcsponders a«4 fun e ral service personnol, 
shall follow blood »ft4 body fluid prec 
autions with (*U patients. 

(9)(4fl» Health care workers with HIV in- 
fection who have secondary infections or 
open skin lesions which would place pa- 
tients at risk shall not provide direct pa- 
tient care. Otherwise, these control 
measures do not require restrictions in the 
workplace of persons with HIV infection. 

(444 All equipment used to punctur e human 
sk4» (h* medical »f other s e ttings) must 
be disposed ef to accordance with G.S. 
90 1 1 3 . '1 A after «se se sterilii'.od prior to 

(10) (42} Local health departments that pro- 
vide testing for HIV infection shall offer 
free anonymous testing with individual 
pre- and post-test counseling. Counseling 
shall include risk- assessment, risk- «s- 
duction guidelines, appropriate test- result 
interpretation, a&4^ when toe person 
tested is determined to be infected with 
1IIV, control measures. 

(11) Appropriate counseling for 1 1 IV testing 
shall include individualized pre- and post- 



test counseling which provides risk as- 
sessment, risk reduction guidelines, 
appropriate referrals for medical and 
psychosocial services, and, when the per- 
son tested is determined to be infected 
with HIV, control measures. 



(12) The State Health Director shall designate 
no fewer than nine nor more than 15 1 1 IV 
testings sites to conduct anonymous test- 
ing. 

(13) A person charged w+to convicted of an 
offense that involves nonconsensual 
vaginal, anal, or oral intercourse, or that 
involves vaginal, anal, or oral intercourse 
with a child 12 years old or less shall be 
tested for HIV infection if: 

(A4 probable cause has been found ef a» 
indictm e nt has been issu e d; 

(A) fB4 the victim notifies the local health 
director and requests information con- 
cerning the HIV status of the defendant; 
and 

(B)(€} the local health director determines 
that the alleged sexual contact involved in 
the offense would pose a significant risk 
of transmission of HIV if the defendant 
were HIV infected. 



NORTH CAROLINA REGISTER 



665 



PROPOSED RULES 



If in custody of the Department of Cor- 
rection, the person shall be tested by the 
Department of Corrections and if not in 
custody, the person shall be tested by the 
local health department. The Department 
of Corrections shall inform the local 
health director of all such test results. The 
local health director shall inform the vic- 
tim of the results of the test, counsel the 
victim appropriately, and instruct the vic- 
tim regarding the necessity for protecting 
confidentiality. 
(g) Health care workers, including emergency 
responders and funeral service personnel, shall 
follow blood and body fluid precautions with all 
patients. 

(h) All equipment used to puncture human 
skin (in medical or other settings) must be dis- 
posed of in accordance with G.S. 90-1 13.4A after 
use or stenli/cd prior to reuse. 

(i) The following are the control measures for 
hepatitis ]} infection: 

( 1 ) Infected persons shall: 

( A ) refrain from sexual intercourse unless 
condoms are used except when the part- 
ner is known to be infected with or im- 
mune to hepatitis B; 

(B) never share needles or syringes; 

(C) not donate or sell blood, plasma, 
platelets, other blood products, semen, 
ova, tissues, organs, or breast milk; 



(D) if the time of initial infection is known, 
identify to the local health director all 
sexual intercourse and needle partners 
since the date of infection; and, if the date 
of initial infection is unknown, identify 
persons who have been sexual intercourse 
or needle partners during the previous six 
months; 

[1 ) lor the duration of the infection, notify 
future sexual intercourse partners of the 
infection and refer them to their attending 
physician or the local health director for 
control measures; 

(I ; ) be tested six months after diagnosis to 
determine if they are chronic carriers^ an- 



ml/kg, 1\1 as soon as possible and within 
two weeks of the last exposure; 

(B) when a person is a household contact, 
sexual intercourse or needle sharing con- 
tact of a person who has remained in- 
fected with hepatitis B for six months or 
longer, the partner or household contact, 
if susceptible, shall be vaccinated against 
hepatitis B; 

(C) when a health care worker or other 
person has a ncedlestick. non-intact skin, 
or mucous membrane exposure to blood 
or body fluids that poses a significant risk 
of hepatitis B transmission, the following 
shall apply: 

(i) when the source is known, the source 
person shall be tested for hepatitis B 
infection, unless already known to be 
infected; 
(ii) when the source is infected with 
hepatitis B and the exposed person is^ 
(I) vaccinated, the exposed person shall 
be tested for anti-HBs. If anti-HBs 
is less than ten SRI by RIA or neg- 
ative by I A, the exposed person 
shall be given hepatitis B immune 
globulin. 0.06 ml kg, IM immediately 
and a single does of hepatitis 13 vac- 
cine within seven davs; 
(111 not vaccinated, the exposed person 
shall be given hepatitis B immune 
globulin, 0.06 ml kg, IM immediately 
and, if at high risk for future expo- 
sure, begin vaccination with hepatitis 
B vaccine within seven days, 
(iii) When the source is unknown and the 
exposed person rv 

(1) vaccinated, no intervention is nec- 
essarv; 



(II) un vaccinated, the exposed person 
shall be given hepatitis B immune 
globulin or immune globulin, 0.06 
ml kg, IM immediately and, if at high 
nsk for future exposure, begin 
vaccination with hepatitis B vaccine 
within seven days. 



nuallv for two years thereafter if thev re- (D) infants born to infected mothers shall 

main infected, and when necessary to be given hepatitis B immune globulin, 0.5 

ml, IM as soon as stabilized and within 
12 hours after birth; vaccinated against 
hepatitis B beginning as soon as possible 
and within seven days following birth; and 
tested for HBsAg at^ 12-15 months of age. 
(3) The following persons shall be vaccinated 
against hepatitis B: 
( A ) health care workers who have potential 
occupational needlestick, mucous mem- 
brane, or non-intact skin exposure to 



and when necessary to 
determine appropriate control measures 
for persons exposed pursuant to Para- 
graph (2) of this Rule. 
(2) The following are the control measures 
for persons reasonably suspected of being 
exposed: 
(A) when a person has had sexual inter- 
course exposure to hepatitis B infection, 
the person shall be given hepatitis B im- 
mune globulin or immune globulin, 0.06 



666 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



blood, blood components, or other po- 
tentially infectious body fluids an average 
of one or more times each month, in- 
cluding but not limited to medical 
technologists and other laboratory work- 
ers exposed to blood, emergency room 
personnel involved in patient care, per- 
sons who draw blood or start IVs, sur- 
geons, personnel who assist in surgery, 
dentists, dental assistants and hygicnists, 
oral surgeons, and patient care stall in 
dialysis units. Health care workers need 
not be tested for susceptibility prior to 
vaccination; however, those who are 
known to be infected or immune are not 
required to be vaccinated; 

(B) persons who are mentally retarded and 
reside in institutions and persons who 
provide direct patient care to mentally re- 
tarded individuals within institutions; 

(C) hemodialysis patients; and 

(D) patients who receive frequent trans- 
fusions of blood products. 

Persons required bv Subparagraphs (B), 
(C), and (D) to be vaccinated may be 
tested for susceptibility to hepatitis B 
prior to vaccination. Those who are 
known to be infected or immune are not 
required to be vaccinated. 

(4) The attending physician shall advise all 
patients known to be at high risk, includ- 
ing injection drug users and men who 
have sex with men, that they should be 
vaccinated against hepatitis B if suscepti- 
ble. 

(5) The following persons shall be tested for 
hepatitis B_ infection: 

(A) pregnant women unless known to be 
infected; and 

(B) donors of blood, plasma, platelets, and 
other blood products. 

Statutory Authority G.S. BOA- 144. 

SECTION .0400 - IMMUNIZATION 

.0405 MEDICAL EXEMPTIONS FROM 
IMMUNIZATION 

(a) Certification of a medical exemption by a 
physician pursuant to G.S. BOA- 156 shall be in 
writing and shall state the basis of the exemption, 
the specific vaccine or vaccines the individual 
should not receive, and the length of time the 
exemption will apply for the individual. 

(b) The following are medical contraindications 
for which medical exemptions may be granted for 
immunizations required by G.S. BOA- 152: 

( 1) Pertussis vaccine: 



(A) Permanent contraindications: 

(l) fever greater than 40.5 C (104.9 I-'), 
hypotonic- hyporcsponsive episode or 
unusual high-pitched crying lasting 
three hours or more, occurring within 
48 hours after receipt of pertussis vac- 
cine; 

(ii) seizure within 72 hours after receipt 
of pertussis vaccine; 

(iii) encephalopathy within seven days 
after receipt of pertussis vaccine; 

(iv) immediate allergic reaction to 
pertussis vaccine manifested by hives 
or anaphylaxis; or 

(v) documented history of culture con- 
firmed pertussis disease. 

(B) Temporary contraindications: 

(i) undiagnosed, unstable, or evolving 
neurological conditions, including sei- 
zures; or 

(ii) acute febrile illness. 

(2) Diphtheria or tetanus toxoids: 

(A) Permanent contraindications: imme- 
diate allergic reaction to diphtheria or 
tetanus toxoids manifested bv hives or 
anaphylaxis. 

(1?) Temporary contraindications: acute 
febrile illness. 

(3) Measles and mumps vaccine: 

( A ) Permanent contraindications: 

(i) significantly immunocompromising 
conditions other than HIV infection; 



(ii) allergic reaction to eggs or neomycin 
manifested by anaphylaxis. 
(B) Temporary contraindications: 
[i] acute febrile illness; 
(ii) pregnancy. 

(4) Rubella vaccine: 

(A) Permanent contraindications: 

(i) significantly immunocompromising 
conditions other than HIV infection; 

(ii) allergic reaction to neomycin mani- 
fested by anaphylaxis. 

(B) Temporary contraindications: 
(i) acute febrile illness; 

(ii) pregnancy. 

(5) I ive polio vaccine: 

(A) Permanent contraindications: 

(i) significantly immunocompromising 

conditions; 
(ii) significantly immunocompromising 

condition in a household contact. 

(B) Temporary' contraindications: 
(i) acute febrile illness; 

(ii) pregnancy. 

Statutory Authority G.S. 1 30 A- 152(c), BOA-/ 56. 



NORTH CAROLINA REGISTER 



667 



PROPOSED RULES 



SECTION .0500 - PURCHASE AND 
DISTRIBUTION OF VACCINE 

.0504 DISTRIBUTION OF VACCINE 

(a) The Department of Environment, Health, 
and Natural Resources may provide vaccines re- 
quired by law to North Carolina universities and 
colleges to administer to eligible college students 
who need vaccines to meet the requirements of 
G.S. 130A-155.1 and 10 NCAC 7A .0401. These 
vaccines may be provided to universities and 
colleges by local health departments acting as 
agents of the state. 

(b) A college or university shall be eligible to 
receive vaccines from the department only if it 
signs an agreement with the local health depart- 
ment serving the county in which it is located. 
This agreement shall be prepared by the 
Immunization Branch and shall require the col- 
lege or university to administer such vaccines 
only to eligible students; to charge only the 
amount it paid for the vaccine and a reasonable 
administration fee; to submit monthly vaccine 
reports on a form prepared by the Immunization 
Branch by the fifth day of each month; to report 
adverse vaccine reactions through the Federal 
Monitoring System for Adverse Events Follow- 
ing Immunization (MSAEFI); to obtain a signed 
Important Information Statement for each dose 
of vaccine administered and to retain the signed 
portion for a period of ten years following the 
end of the calendar year in which the form was 
signed, or for ten years following the recipient's 
age of majority, whichever is longer, and upon 
request, furnish copies of the signed portion to 
the Department, the above local health depart- 
ment, or the Centers for Disease Control, De- 
partment of Health and Human Services; to keep 
a record of the vaccine manufacturer, lot number, 
and date of administration for each dose of vac- 
cine administered; to allow periodic inspection 
of its vaccine supplies and records by the 
Immunization Branch; and to comply with the 
rules of this Section. 

(c) Students shall be eligible to receive state 
provided vaccines only if the dose is necessary to 
bring the student into compliance with G.S. 
130A- 155.1 and 10 NCAC 7A .0401. 

(d) A college or university that fails to submit 
timely and accurate reports, as required in Para- 
graph (b) of this Rule, twice in any 12 month 
period shall have its eligibility to receive state 
provided vaccine suspended for a period of one 
year. A college or university that fails to comply 
with any of the other requirements of this Rule 
may have its eligibility suspended by the Depart- 
ment for a period determined by the Department 
and may be subject to an action brought pursu- 



ant to G.S. 130A-27. All suspensions of eligi- 
bility shall be in accordance with G.S. 130A-23. 

Statutory Authority G.S. I30A-I55.I; 130A-433. 

SUBCHAPTER 7C - OCCUPATION AU HEALTH 
BRANCH 

SECTION .0200 - DUSTY TRADES PROGRAM 

.0204 CHEST X-RAYS 

(a) Annual Chest x-rays shall be provided in 
accordance with G.S. 97-60 for employees of 
companies that have been designated by the 
North Carolina Industrial Commission as dusty 
trades. 

Statutory Authority G.S. 97-60; 130A-5(3). 

.0205 ADVISORY MEDICAL COMMITTEE 

(a) The Advisory Medical Committee consists 
of three members who are appointed by the In- 
dustrial Commission and approved by the Gov- 
ernor. 

be Fes4 by a member »f the Advisor/ Medical 
Committee. 

(«)• 34re Ad vino ry Medical Committee member 
who reads a«4 evaluates x rays shall be compon 

(b) (4) Each member shall be paid one hundred 
dollars ($100.00) per month for conducting ex- 
aminations and making reports and for assisting 
in any post mortem examinations when so di- 
rected by the North Carolina Industrial Com- 
mission. 



Statutory Authority 
130A-5(3). 



G.S. 97-69; 



97-73; 



SECTION .0600 - ASBESTOS HAZARD 
MANAGEMENT PROGRAM 

.0601 GENERAL 

(a) The definitions contained in G.S. 130A-144 
and the following definitions shall apply 
throughout this Section: 



( 1) "Management Consultant" means a per 



son who performs administration or 
oversight services before, during or after 
asbestos abatement activities. 
(2) "Air Monitor" means a person who per- 
forms visual inspections or takes air sam- 
~>les for abatement clearance activities or 



who takes ambient air samples in 
buildings. 
(3) "Program" means the Asbestos Hazard 
Management Program. 



668 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



{b} 44w Asbestos m Buildings Program (A1BP), 
Division &f 1 l e alth Servic e s, has boon designated 
fey- tfe* Governor to implement The Asbestos 
Hazard Emergency Response Act, (Alll ' RA), 
P.L. 99-519 and the Environmental Protection 
Agency (EPA) rules 40 CFR Part 763 and ac- 
companying appendices, which hav e boon are 
adopted by reference in accordance with G.S. 
150B-14(c). 

Statutory Authority G.S. 130A-5(3); P.L. 99-5/9. 

.0602 ACCREDITATIONS 

(a) No person shall commence ef continue to 
engage i» tfee business »f performing inspections, 
writing management piano, designing abatement 
actions, performing abatement work e* supen i 'in 
iftg abatement work relating te asbestos m 
schools perform asbestos management activities 
until that person has been accredited by the 
Program in the specific discipline fof tfe« activity 
being performed, appropriate accreditation cat- 
egory, except as provided for in G.S. 130A-447, 
(b) and (c). 

(b) An applicant for accreditation shall meet 
the provisions of the "EPA Model Contractor 
Accreditation Plan" contained in 40 CFR 763 
(Subpart E, appendix C). 

(c) In addition to the requirements in (b), an 
applicant shall meet the following: 

(1) an applicant for initial accreditation shall 
have successfully completed an approved 
initial training course ef a» approved h»- 
fresher training course within the 12 
months immediately preceding applica- 
tion or if initial training was completed 
more than 12 months prior to application, 
the applicant shall have successfully com- 
pleted an approved refresher training 
course at least every 14 months from the 
date of completion of initial training to 
the date of application. U more than +4 
months h+» elapsed betw e en a«y training 
cours e s, initial training must be repeated; 

(2) an inspector shall have: 

(A) a high school diploma or equivalent; 
and 

(B) at least three months asbestos related 
experience under direct supervision of an 
accredited inspector, or at least one month 
of employment as an accredited supervi- 
sor, or at least six months employment as 
an accredited worker, or equivalent expe- 
rience; 

(3) a management planner shall have a high 
school diploma or equivalent and shall be 
an accredited inspector; af>4 

(4) a contractor »f supervisor shall have: 



(A) a high school diploma or equivalent; 
and 

(B) at least three months asbestos related 
experience as, or under the direct super- 
vision of, an accredited supervisor or at 
least three months employment as an 
asbestos worker, or equivalent experience; 

(5) an abatement designer shall have: 

(A) a high school diploma or equivalent; 
and 

(B) at least three months asbestos related 
experience as, or under the direct super- 
vision of, an accredited abatement de- 
signer or at least three months 
employment as an accredited supervisor, 
or equivalent experience; 

(6) a management consultant shall: 

(A) be a professional engineer, registered 
architect or a certified industrial hvgienist 
or have four years experience as an abate- 
ment designer or supervisor; and 

(B) have one year experience in asbestos 
related work within the past four years 



and be accredited as a management plan- 
ner and a designer. 
(7) an air monitor shall: 

(A) he a certified industrial hvgienist or 
work only under the supervision of a cer- 
tified industrial hvgienist that is accredited 
as an air monitor; and 

(B) have completed the National Institute 
for Occupational Safety and Health 582 
training course or equivalent; and 

(C) have three months asbestos related ex- 
perience or equivalent within 12 months 
following the most recent accreditation or 
rcaccreditation. 

(d) To obtain accreditation, the applicant shall 
submit, or cause to be submitted, the following 
information to the Asbestos m Buildings Pro- 
gram on application forms provided by the Pro- 
gram: 

( 1 ) full name and social security number of 
applicant; 

(2) name, address and telephone number of 
employer; 

(3) discipline^ s) applied for; 

(4) datc(s) of training course(s) for each dis- 
cipline; 

(5) name an4 location feity a«4 site} of course 
attended; 

(6) training agency name and address; 

(7) confirmation of completion of an ap- 
proved initial or refresher training course 
from the training agency; sefrt- directly te- 
tfee program; the confirmation shall be in 
the form of an original certificate of com- 
pletion of the approved training course 



NORTH CAROLINA REGISTER 



669 



PROPOSED RULES 



bearing the training agency's official seal, 
or * l e tt e r an original letter from the 
training agency confirming completion of 
the course on training agency letterhead, 
or a list- ef an original letter from the 
training agency listing names of persons 
who have successfully completed the 
training course, with the applicant's name 
included, on the training agency letter- 
head; 

(8) when education is a requirement, a copy 

of the diploma or other written doc- 
umentation from the educational institu- 
tion; and 

(9) when experience is a requirement, work 

history documenting asbestos related ex- 
perience, including employer name, ad- 
dress, and phone number; positions held; 
and dates when the positions were held, 
(e) All accreditations, including accreditations 
issued prior to October 10, 1988, shall expire at 
the end of the 12th month following completion 
of required initial or refresher training. To be 
reaccredited, an applicant shall have completed 
the required refresher training course within 14 
months after the initial or refresher training 
course. An applicant for reaccreditation shall 
also submit information specified in (d)( 1 )-(d)(7). 
If a person fails to obtain reaccreditation within 
two calendar months after the expiration date of 
original accreditation, that person may be ac- 
credited only by meeting the requirements of 
Paragraphs (b), (c), and (d). 
ff4 Pursuant t» the requirements fof refresher 
training courses m 40 CTR ?65r Subpart \*~ Ap- 
pendix Gr the stato has determined that- refresher 
training courses shall include a review &f the fol- 
1 owing key- aspects »f the initial training course: 
(44 the refresher training course fof ah disci 
plines shall include a review »f health et- 
feots ef asbestos, respiratory protection, 
a«4 personal protective equipment; 
(-2-^ the refresher training course fof inspector 
shall include a review »f recordkeeping, 
writing the inspection r e port, inspecting 
fof friable affo non friable asbestos 
containing material. a«4 assessing the 
condition ef asbestos containing building 
materials; 
(44 the refresher training cours e fof manage 
ment planner shall includ e a review ef 
recordkeeping, management plan content, 
hazard assessment, determining as oper 
at ions atfo maintenance plan. a&4 se- 
lection ef control options; 
(4* the refresher training course fof abatement 
project designer shall includ e a r e vi e w ©f 
designing abatement solutions, 



budgeting cost estimation, considerations 

abatement specifications; 
(4) the refresher training course fof 

contractor supervisor shall include a fe- 
view »f state of th e art work practices, atf 
monitoring a«4 supervisory t e chniques; 

f6} the refresher training course fof abatement 
workers shall include a r e view ef state of 
the art work practices, personal hygiene, 
afi4 additional safety hazards. 

(f) Persons applying for reaccreditation as an 
air monitor shall have obtained at least one 
month of asbestos related experience within 12 
months following the most recent accreditation 
or reaccreditation. 

(g) All accredited persons shall be assigned an 
accreditation number by the program. 

(h4 A hst ef approved training courses shall be 
available from the program. 

(h) ff} Upon request, a person accredited by 
another state shall be accredited by the program 
if that state's accreditation program is at least as 
stringent and as comprehensive as the accredi- 
tation program established by these rules. 

(£ fa 44*e In accordance with G.S. 130A-23, 
the Program may revoke accreditation or reac- 
creditation for anv violation of G.S. 130A, Arti- 



cle J_9 or anv of the rules of this Section, or upon 
a finding that its issuance was based upon incor- 
rect or inadequate information that materially 
affected the decision to issue accreditation or re- 
accreditation. The Program may also revoke 
accreditation or reaccreditation upon a finding 
that the accredited person has violated a generally 
accepted, industrywide anv standard ©f practic e , 
affo the violation creates a significant public 
health hazard, referenced in Rule .0606(e) of this 
Section. A person whose accreditation is re- 
voked because of fraudulent misrepresentations 
or because of violations that create a significant 
public health hazard shall not be authorized to 
reapply for accreditation before three months af- 
ter the revocation and must repeat the initial 
training course and other requirements as shown 
in Paragraphs (c)(l)-(c)(4) of this Rule. 

Statutory Authority G.S. 130.4-5(3); PL. 99-519. 

.0603 ASBESTOS MANAGEMENT PLANS 
(REPEALED) 

Statutory Authority G.S. 130A-5{3); PL. 99-519. 

.0604 APPROVAL OF TRAINING COL RSES 

(a) Pursuant to Rule .0602 of this Section, ap- 
plicants for accreditation and reaccreditation are 



670 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



required to successfully complete training courses 
approved by the Program. In order to be ap- 
proved by the Program, training programs shall 
meet the requirements of 40 CER 763, Subpart 
E, Appendix C, and the requirements of this 
Rule. A list of approved training courses shall 
be available from the Program. 

(b) Refresher training courses shall include a 
review of the following key aspects of the initial 
training course: 

(1) the refresher training courses for all disci- 
plines shall include a review of health ef- 
fects of asbestos, respiratory protection, 
and personal protective equipment; 

(2) the refresher training course for inspector 
shall include a review of record keeping, 
writing the inspection report, inspecting 
for friable and non-friable asbestos- 
containing material, and assessing the 
condition of asbestos containing building 
materials; 

(3) the refresher training course for manage- 
ment planner shall include a review of re- 
cord keeping, management plan content, 
hazard assessment, determining an oper- 
ations and maintenance plan, and se- 
lection of control options; 

(4) the refresher training course for abatement 
project designer shall include a review of 
designing abatement solutions, budgeting/ 
cost estimation, considerations for work 
in occupied buildings and writing abate- 
ment specifications; 

(5) the refresher training course for supervisor 
shall include a review of state-of-the-art 
work practices, air monitoring and super- 
visory techniques; and 

(6) the refresher training course for abatement 
worker shall include a review of state-of- 
the-art work practices, personal hygiene, 
and additional safety hazards. 

(c) Training courses approved by the Environ- 
mental Protection Agency of any state authorized 
by the Environmental Protection Agency to ap- 
prove training courses shall be deemed approved 
by the Program unless approval is suspended or 
revoked in accordance with Paragraph (g) of this 
Rule. 

(d) Applicants for training course approval 
shall submit to the Program a description of the 
course content, including the instructor's guide, 
student handout materials, and a description of 
the required examination. 

(e) Training course sponsors shall permit Pro- 
gram representatives to attend any training 
course without charge for the purpose of evalu- 
ating compliance with these rules. 



(f) In accordance with G.S. 130A-23, the Pro- 
gram may suspend or revoke approval for a 
training course for violation of this Rule and 
shall suspend or revoke approval upon suspen- 
sion or revocation of approval by the Environ- 
mental Protection Agency or any state 
authorized by the Environmental Protection 
Agency to approve training courses. 

Statutory Authority G.S. l30A-5(3); I30A-447; 
P.L. 99-5/9. 

.0605 ASBESTOS MANAGEMENT PLANS 

(a) All Local Education Agencies shall submit 
Asbestos Management Plans for school buildings 
to the Program on forms provided by the Pro- 
gram. Asbestos Management Plans shall meet 
the requirements contained in 40 CER 763. 

(b) In addition to the requirements in Para- 
graph (a) of this Rule, the management plan shall 
comply with the following: 

(1) All Asbestos Containing Building Materi- 
als shall be identified, located, classified 
and assessed; and 

(2) The Local Lducation Agency shall notify 
the Program of asbestos removal projects 
within ten working days after the removal 
area has been cleared for occupancy. 

Statutory Authority G.S. i30A-5(3); I30A-445; 
P.L. 99-5/9. 

.0606 ASBESTOS CONTAINING MATERIALS 
REMOVAL PERMITS 

(a) No person shall remove more than 35 cubic 
feet, 160 square feet or 260 linear feet of friable 
asbestos containing material, or non-friable 
asbestos containing material that may become 
friable during handling, without a permit issued 
by the Program. Other asbestos abatement ac- 
tivities are exempt from the permit requirements 
of G.S. 130A-449. 

(b) Applications for asbestos containing mate- 
rial removal permits shall be submitted to and 
received by the Program at least ten working days 
prior to the scheduled removal date. However, 
for asbestos removal determined by the Program 
to require immediate action, the ten day notice 
shall not be required. The application shall be 
made on a form provided by the Program and 
shall contain the information in Paragraphs 
(b)(l)-(b)(9) of this Rule. If immediate action 
is necessary, the applicant shall supply the infor- 
mation required on the application plus an at- 
tachment containing the additional information 
in Paragraphs (b)(10)-(b)(13) of this Rule. 

(1) Contractor information; 

(2) Project location information; 



NORTH CAROLINA REGISTER 



671 



PROPOSED RULES 



(3) Facility description; 

(4) Removal dates; 

(5) Description, location and amount of 
asbestos material to be removed; 

(6) Permit fee information; 

(7) Disposal methods; 

(8) Notification of other agencies; 

(9) Cause of damage relating to immediate 
problem; 

(10) Date when damage occurred; 

(11) Agency requesting immediate action; 

(12) Public health affects; and 

(13) Names of accredited personnel involved. 

(c) The permit holder shall notify the Program 
of any change in the removal schedule at least 
three working days prior to the removal. 

(d) Copies of the following shall be maintained 
on site during removal activities and be imme- 
diately available for review by the Program: 

( 1) copy of the removal permit; 

(2) applicable specifications and contract 
documents; 

(3) disposal information, including any au- 
thorization for disposal; 

(4) identification and accreditation informa- 
tion for all personnel performing removal 
activities. 

(e) All permitted removal activities shall be 
conducted in accordance with the Toxic Sub- 
stances Control Act, 15 USC 2601; 29 CFR 
Parts 1910 and 1926; 40 CFR Parts 61 and 763; 
Fnvironmental Protection Agency's Guidance 
for Controlling Asbestos-Containing Materials in 
Buildings, 560 5-85-024 except paragraphs 6.4.1 
Visual Inspection and 6.4.2 Air Testing; Envi- 
ronmcntal Protection Agency's A Guide to Re- 
spiratory Protection for the Asbestos Abatement 
Industry, 560-OPTS-86-001 except Part II C. 
Respirator Selection; Fnvironmental Protection 
Agency's Measuring Airborne Asbestos Follow- 
ing An Abatement Action, 600/4-85-049; Ameri- 
can National Standards Institute's Respiratory 
Protection, Respirator Use, Physical Qualifica- 
tions for Personnel, Z88.6-1984; American Na- 
tional Standards Institute's Practices for 
Respiratory Protection, Z88.2-1980; American 
National Standards Institute's Fundamentals 
Governing the Design and Operation of Focal 
Fxhaust Systems, Z9.2-1979; 49 CFR Part 173; 
G.S. Chapters 97 and BOA, which are hereby 
adopted by reference in accordance with G.S. 
150B- 14(c). 

(f) In accordance with G.S. 130A-23, the Pro- 
gram may suspend or revoke the permit for any 
violation of G.S. 130A, Article 19 or any of the 
rules of this Section. The Program may also re- 
voke the permit upon a finding that its issuance 
was based upon incorrect or inadequate infor- 



mation that materially affected the decision to 
issue the permit. 

Statutory Authority G.S. l30A-5(3); I30A-449; 
P.L. 99-519. 

.0607 FEES 

(a) The fee required by G.S. 130A-450 shall be 
submitted with an application for the asbestos 
containing material permit. The amount of the 
fee is one percent of the contract price or twenty 
cents ($0.20) per square or linear foot, whichever 
is greater. A permit shall not be issued until the 
required fee is paid. However, when the Pro- 
gram has determined that immediate action is 
necessary, the fee shall not be required to be 
submitted with the application, but shall be sub- 
mitted to and received by the Program within five 
working days of issuance of the permit. 

(b) The fee required by G.S. 130A-448 shall 
be submitted with an application for accredi- 
tation or reaccreditation. The amount of the fee 
shall be one hundred dollars ($100.00) for each 
category, except that the fee for persons applying 
for accreditation or reaccreditation as workers 
shall be twenty-five dollars ($25.00). A person 
shall not be accredited or reaccredited until the 
required fee is paid. 

Statutory Authority G.S. I30A-5(3); 130A-448; 
I30A-450; P.L. 99-519. 

.0608 ASBESTOS EXPOSURE STANDARD 
FOR PLBEIC AREAS 

(a) The maximum allowable ambient asbestos 
level for public areas shall be 0.01 fibers per cubic 
centimeter of air based on the fiber level obtained 
during the actual sample time. 

(b) The sampling and analysis method used to 
determine the ambient asbestos fiber level in 
buildings shall be either phase contrast 
microscopy or transmission electron microscopy. 

(c) The sampling and analysis method used to 
determine the fiber level for clearance after an 
abatement action shall be either phase contrast 
microscopy or transmission electron microscopy, 
except that local education agencies shall meet 
Asbestos Hazard Emergency Response Act re- 
quirements. 

(d) Phase contrast microscopy or transmission 
electron microscopy sampling and analysis 
methods shall be conducted in accordance with 
40 CFR Part 763. 

(e) Sample analysis for phase contrast 
microscopy or transmission electron microscopy 
samples shall be performed by a laboratory 
meeting the requirements of P.F. 99-519 and 40 
CFR 763 and accompanying appendices. 



672 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



Statutory Authority G.S. 
P.L. 99-5/9. 



I30A-5(3); I30A-446; 



SUBCHAPTER 7G - VITAL RECORDS 

SECTION .0300 - BIRTH REGISTRATION 

.0302 LATE CERTIFICATES NOT SIGNED 
BY AIT END ANT 

Certificates of birth filed after five ten days but 
within one year from the date of birth which are 
signed by someone other than the attendant must 
be accompanied by a statement from the local 
registrar stating why the certificate cannot be 
signed by the attendant. The State Registrar may 
require additional evidence in support of the facts 
of birth or an explanation for the delay in filing. 

Statutory Authority G.S. !30A-92(7). 

.0303 PHYSICIAN'S SIGNATURE 

A birth certificate must be completed and signed 
by the physician or other person in attendance 
at birth within five ten days after birth. If the 
certificate has not been completed by the physi- 
cian or other person in attendance within five ten 
days, the hospital administrator may complete 
and sign the certificate. 

Statutory Authority G.S. l30A-92(7). 

CHAPTER 8 - HEALTH: PERSONAL HEALTH 

SUBCHAPTER 8A - CHRONIC DISEASE 

SECTION .1200 - HEALTH CARE SERVICES IN 
THE HOME DEMONSTRATION PROGRAM 

.1202 DEFINITIONS 

The following definitions shall apply through- 
out this Section: 
(21) "Demonstration Program Reimbursement 
Rate" is the: 

(a) agency rate or the maximum Medicaid 
rate, whichever is lower, for nursing ser- 
vices, home health aide services and ther- 
apy services, and home mobility aids and 
telephone alert systems; physicians i^ef- 
vicos, physician assistant services , family 
nurse practitioner services, nutritionist 
services, psychologist sen ices; 

(b) interim Medicare rate for medical social 
services, durable medical equipment and 
ancillary medical supplies; which includ e s 
homo mobility aid* »h4 telephone alert 
systems; and 

(c) schedule of payments that shall be devel- 
oped by the Division of 1 Iealth Services 



Adult Health for assessment evaluation 
services, self-care education services, nu- 
trition services, case management services, 
physicians services, physician assistant 
services, family nurse practitioner services, 
psychologist services and other covered 
services for which neither Medicaid nor 
Medicare has an established reimburse- 
ment rate. 

Statutory Authority G.S. I30A-223. 

SUBCHAPTER 8B - MATERNAL AND CHILD 
HEALTH 

SECTION .0100 -SCHOOL HEALTH FUNDS 

.0110 GENERAL 

(a) The purpose of the school health fund is to 
enhance the provision of preventive, diagnostic, 
evaluative, and treatment a«4 prosthetic services 
to school age children and by giving impetus te 
th«» development ef cooperation to develop co- 
operative arrangements among local health de- 
partments, schools, the private medical s e ctor 
health care providers and hospitals. Funds are 
provided to local health departments to assist 
families of eligible school children. i» the pfe- 
vention ©I nuisance infectations »ft4 i» the pfe- 
vention »f correction ef chronic, remediable 
physical defects. 

(b) Local health departments The school health 
fund ate is administered by the Child and Ado- 
lescent Section, Division of Maternal and Child 
Health, Branch, Division of Health Sen ices, 
P.O. Box 2<Wt 27687, Raleigh, North Carolina 
27602. 27611-7687. 

Statutory Authority G.S. 130.1- 124. 

.01 1 1 ALLOCATION OF FUNDS 

School health funds afe shall be allocated to lo- 
cal health departments. One thousand dollars 
($1,000) per year shall be allocated for each 

r*l~\11nt\* II itlun * K.i ii in.-.li ->* « .-» «i rii t K ,-y I.a/"i1 Kii.iMFi 

V. \J Ul 1 I > . "" 1 1 I 1 1 1 1 CXW Jill 1 ^J ll'lll 'II CTT I T IV TTTTOT I Ivw III 

department. Additional amounts are allocated 
per county based on a determined amount pef 
pupil i» each county's average daily attendance 
for the previous school year as shown in the re- 
cords provided to the Division by the North 
Carolina Department of Public Instruction. The 
allocation of funds to any county may be modi- 
fied to reflect actual utilization of funds. 

Statutory Authority G.S. 130A-/24. 

.0112 BUDGETING OF FUNDS 

School health funds will shall be budgeted as a 
separate line item entitled "School Health'' 



NORTH CAROLINA REGISTER 



673 



PROPOSED RULES 



within each local health department's Mat e rnal 
««4 Child I lealth budget. 

Statutory Authority G.S. I30A-I24. 

.0113 CLIENT ELIGIBILITY 

(a) To be eligible for services paid for through 
the school health fund, clients must: shall: 

( 1 ) meet the residency a«4 financial require- 
ments of 10 NCAC 4C; 

(2) meet the financial requirements of 10 
NCAC 4C or the l.S. Department of 
Agriculture Financial Scale for the free 
lunch program; 

(3)f2j be less than 20 years of age; and 
(4)f4-fr be attending enrolled in a public or 

private school, grade kindergarten through 

grade 12. a«4 
(4) must have a health problem toat- without 

treatment may result » a chronic, 

remediable physical defect. 

(b) When financial eligibility for school health 
funds is based upon the Free Lunch Program's 
income eligibility scale, written verification munt 
shall be obtained from the local school system 
and retained for audit purposes or a financial de- 
termination shall be performed by the local 
health department. 

Statutory Authority G.S. 130A-I24. 

.01 14 USE OF SCHOOL HEALTH FUNDS 

(a) School health funds may be used: 

(1) to provide reimbursement for the follow- 
ing services: 

preventiv e , diagnostic, evaluative, treat 
ment. aft4 prosthetic medical ef dental 
services, a«4 prescription medications Fe- 
quired kn= toe prevention »f correction ef 
chronic, remediable physical defects wt el- 
igiblo school children. 

( A ) preventive, diagnostic and evaluative 
treatment services: 

(B) psychosocial, emotional and nutritional 
counseling; and 

(C) medications. 

fb} Medications may be purchased » bulk «*- 
»g school health funds 

(2) to purchase bulk medications under the 
following conditions: 

(A) f44 Written approval for the purchase 
and use of such medications is obtained 
from the medical consultant to the local 
health department; 

(B) ffo The proper use of such medications 
is described by- in the written standing or- 
ders of a person entitled to prescribe 
medications in North Carolina; or 



(C) Medications for the treatment of 
infestations are distributed without prcau- 
thori/.ation to school ace children and for 



their immediate families. 



& 



(4) 



(3) 

(4) 

(5) 



That when appropriat e , M*eb medications 
afe dispensed to patients m accordance 

T 1 | 1 t Vl if'lt J 'Al^^i t^ta^*^tii 1 I 1 I .. ^\jl £^illl^ 

lationo; 

Di ' .itribution ef- medication * ) purchased 
with school health funds must be made 
e« a p reauthorized basis afto only to el+- 
gible children. 44te only exception to tfes 
requirement is m toe distribution ef bulk 
medications to school age children a«4 
their imm e diate families fop tr e atment ef 
nuisance infectations. 
(b) fe) School health funds shall not be used for 
the following: 

(1) salaries of personnel; 

(2) transportation; 
office supplies or equipment; 

mass preventive services (water 
fluoridation, for example); 
services covered by other third party re- 
imbursement sources when the health de- 
partment has knowledge of coverage at 
time of authorization; 

(6) eafe ef acute injuries unless tbe health 4»- 

r e ctor &f m e dical consultant authoriz e s 
toe eafe a* requir e d to pr e v e nt a chronic, 
remediable physical defect; services man- 
dated to be provided bv another public 
agency; 

(7) orthodontic treatment; except fop thos e 
orthodontic preventive treatment s e rvices 
a* defined m tbe American Dental Asso 
ciation's Code e« Dental Procedures a»4 
Nomenclature. 

(8) inpatient services: and 

(9) health department services except as al- 
lowed in Rule .01 15(d) of this Section. 

Statutory Authority G.S. J30A-/24. 

.0115 AUTHORIZATION AND 
REIMBURSEMENT 

(a) The local health department shall authorize 
each service sponsored by school health funds, 
Vr4to &e e«e exception except as stated in Sub- 
paragraph (b)(1) (a)(2) of Rule .0114. 

(b) The authorization shall be sent to the an- 
ticipated providers of care for each authorized 
service. The authorization shall include, b«4- &&*■ 
be limit e d to at least the following information: 

(1) name of client; 

(2) medical dental service authorized; 

(3) expiration date of authorization; 

(4) amount authorized; and 



674 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(5) signature of authorizing official. 

(c) The local health department shall negotiate 
rates of reimbursement for services to be pro- 
vided under the school health fund. These rates 
shall not exceed the Medicaid rate of reimburse- 
ment in effect at the time the claim is received 
by the Division. 

(d) Services provided by a dentist employed by 
the local health department trim may be charged 
to school health funds. Claims must shall be 
paid at a rate not to exceed the current Medicaid 
rate in effect for dental services provided in local 
health departments. 

(e) If a local health department's dental pro- 
gram is supported by other state and or or federal 
dollars, the local health department must shall 
be able to demonstrate that toe total dental 
charges to the school health fund docs do not 
exceed the difference between the total cost of the 
dental program and the total state and or or fed- 
eral dollars going into the dental program. 

(f) Services provided by public health dentists 
employed by the Division may shall not be 
charged to school health funds. 

(g) Other rules governing authorization and 
billing processing, procedures, payment limita- 
tions, and limitations on billing clients sponsored 
bv school health funds are found in 10 NCAC 
4C. 

Statutory Authority G.S. I30A-124. 

.0116 MONITORING AND EVALUATION 

The local health department shall complete and 
submit the annual school health fund report 
(DHS 3147) to the Division of Maternal and 
Child Health. Krunch. 

Statutory Authority G.S. I30A-124. 

SECTION .0900 - RURAL OBSTETRICAL CAKE 
INCENTIVE FUNDS 

.0902 APPLICATION FOR FUNDS 

(b) A county is considered underserved with 
respect to obstetrical care if the county meets one 
or more of the following criteria, listed in order 
of priority: 

(4) the county has inadequate obstetrical 
coverage, demonstrated by such factors as 
a waiting list of 28 calendar days or more 
for an appointment at the public prenatal 
clinic; w 50 percent or more of resident 
live-births occurring occur outside «*f the 
county; the five vcar infant mortality or 
premature birth rate is greater than the 
five \ ear state rate; the percentage of resi- 
dent live births to women who received 



no prenatal care or inadequate prenatal 
care exceeds the state rate; 50 percent or 
less of physicians who practice obstetrics 
m the county except Medicaid recipients 
in their private practice; more than 15 
percent of resident live births are to 
women who receive their prenatal care 
from public clinics; the percentage of resi- 
dent live births to women who initiated 
prenatal care in the first trimester is lower 



than the state rate; or the percentage of 
resident live births to women who initi- 
ated prenatal care in the third trimester i^> 
greater than the state rate. 
(-§} implementation t»f these ruler , would pfe- 
sefve county obst e trical sefviees threat 
ened with discontinuation. 

Statutory Authority S. L. I9S7, c. 1100, s. 39.3. 

.0904 DISBURSEMENT OF FUNDS 

(a) Subject to the availability of funds, the 
Maternal and Child Health Branch shall disburse 
rural obstetrical care incentive funds to local 
health departments that have submitted an ap- 
proved application as follows: 

( 1 ) first priority shall be given to those coun- 
ties that meet the criteria in Rule 
0902(b)(1). second priority shall be given 
to those counties that meet the criteria in 
Rule 0902(b)(2), third priority shall be 
given to those counties that meet the cri- 
teria in Rule .0902(b)(3), and fourth pri- 
ority shall be given to those counties that 
meet one or more of the criteria in Rule 
.0902(b)(4): a*4 toto priority toaW be 
giv e n to thos e counties that meet toe eri- 
t#ftrt H»R-*4t» OU()2(h)(5); 
(3) counties funded during ^ 1QSS S9 shall 
receive ongoing funding based upon a re- 
newal application that has been reviewed 
and approved bv the Division of Maternal 
and Child 1 [ealth. which continues to 
meet the requirement '. *4 Rule .09 1 )2. 

Statutory Authority S. L. 19S7, c. 1100. s. 39.3. 

.0906 PARTICIPATION REQUIREMENTS 
I OR PHYSICIANS 

(a) A participating physician shall: 
(5) agree to serve Medicaid recipients who 
request prenatal care through the physi- 
cian's private practice or the local health 
department or other public clinic. 

Statutory Authority S. L. /9.S' 7 , c. 1100, s. 39.3. 



NORTH CAROLINA REGISTER 



675 



PROPOSED RULES 



SUBCHAPTER 8C 



- NUTRITION AND DIETARY 
SERVICES 



SECTION .1100 - VVIC PROGRAM FOOD 
DISTRIBUTION SYSTEM 

.1 106 AUTHORIZED WIC VENDORS 

(b) In order to participate in the WIC program, 
the vendor shall: 

(16) Maintain a minimum inventory of eligi- 
ble food items in the store for purchase 
by WIC Program participants. All such 
foods shall be within the manufacturer's 
expiration date. The following items and 
sizes constitute the rninimum inventory 
of eligible food items for stores classified 
1 -4: 
Food Item Type of Inventory 



Quantities Required 



Total of 6 gallons 
fluid milk 



Total of 5 quarts 
when reconstituted 



Total of 6 pounds 
Total of 12 boxes 

6 dozen 



( 



Milk 



Cheese 
Cereals 

Eggs 
Juices 



Dried Peas 
and Beans 
or 

Peanut Butter 

Infant 
Fruit Juice 

Infant 
Cereal 



Infant 
Formula 



Whole fluid: gallon 

and half gallon 

-and- 
Skim lowfat fluid: 
gallon or half gallon 

Nonfat dry: quart 
package 
-or- 
Fvaporated: 12 oz. 
can 

2 types 

4 types (minimum 
box size 7 oz.) 
Grade A, large or 
extra-large: white 
or brown 

Orange juice must be 
available in 2 types. 
A second flavor must 
be available in 1 
type. The types are: 

12 oz. frozen, 46 oz. 
can, 64 oz. container 

2 types 

18 oz. jars 

2 juices; 4.2 oz. jars 

2 cereal grains; 
8-oz. boxes (one 
must be rice) 

2 types; or 1 type 
contracted for by 
the WIC program 
and designated on 
the food instrument; 

13 oz. concentrate 



6 of each type 
in stock 



3 one-pound bags 
3 jars 

30 jars 

6 boxes 



62 cans 

For store classification 5, the following applies: 
Supply within 48 hours of verbal request by local 
WIC agency staff any of the following products: 
Nutramigen, Portagen, Pregestimil, Similac Spe- 
cial Care 24, Similac 60/40, Similac (Fow-Iron), 
Enfamil (Fow-Iron), SMA Low Iron, Ensure, 
Ensure Plus, Osmolite, Sustacal HC, Sustacal, 
Isocal, Enrich, Enfamil Premature, PediaSure, 
Polycose and MCT Oil. All vendors (classifica- 
tions 1 through 5) shall supply milk or soy based, 
32 oz. ready-to-feed or powdered infant formula 
upon request. 

Statutory Authority G.S. 1 30 A- 361. 

CHAPTER 9 - HEALTH: LABORATORY 

SUBCHAPTER MD - CERTIFICATION AND 
IMPROVEMENT 



( 



I 



676 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



SECTION .0300 - LABORATORY 
CERTIFICATION 

.0.109 CHEMISTRY QUALITY CONTROL 

(d) In addition, analysis for regulated volatile 
organic chemicals under 10 NCAC 11)1) .1624(e) 
shall only be conducted hv laboratories that have 
received conditional approval by 1 I'A or the 
Department according to 40 CRR. 
141 ,24(Ci)( 10) and (11) which Is hereby adopted 
by reference pursuant to G.S. 150B- 14(c). 

(e) Analysis for unregulated volatile organic 
chemicals under 10 NCAC [0D .1638 shall only 
be conducted by laboratories approved under 
Paragraph (d) of this Rule. In addition to the 
requirements of Paragraph (d) of this Rule, each 
laboratory analyzing for FDB and DBCP shall 
achieve a method detection limit for IDB and 
DBCP of 0.00002 mg/1, according to the proce- 
dures in Appendix B of 40 C.I .R. Part 136 
which is hereby adopted by reference pursuant to 
G.S. 150B- 14(c). 

Statutory Authority G.S. I30A-3I5. 

.0317 MICROBIOLOGY QUALITY CONTROL 

Requirements for quality control of microbi- 
ological analyses are as follows: 
(4) An acceptable performance level of 75 per- 
cent shall be maintained for each anal\1e for 
which a laboratory is or wishes to be certi- 



fied. This 75 percent average shall be cal- 
culated from the ten most recent 
performance sample data points from the 
water performance studies, double-blind, 
blind, and on-site samples (when available). 

Statutory Authority G.S. I30A-3I5. 

CHAPTER 10 - HEALTH SERVICES: 
ENVIRONMENTAL HEALTH 

SUBCHAPTER 10A - SANITATION 

SECTION .0400 - SANITATION OF 

RESTAURANTS AND OTHER FOODHANDLING 

ESTABLISHMENTS 

.0443 DEFINITIONS 

The following definitions shall apply in the in- 
terpretation and enforcement of this Section: 
(l) "Approved" means determined by the 
Department to be in compliance with this 
Section. Food service equipment which 
meets National Sanitation Foundation stan- 
dards or equal shall be considered as ap- 
proved. Food which complies with 
requirements of the North Carolina Depart- 
ment of Agriculture or L'nitcd States De- 
partment of Agriculture and the 



requirements of this Section shall be con- 
sidered as approved. 
(2) "Department of Human Rsr . ources Fnvi- 
ronment, Health and Natural Resources" or 
"Department" means the North Carolina 
Department of Human Resources. Fnvi- 
ronment, Health and Natural Resources. 



The term also means the authorized repre- 
sentative of the Department. 

(3) "Drink stand" means and includes those 
establishments in which only beverages are 
prepared on the premises and are served in 
containers (glasses, mugs, etc.) other than 
single-service containers. 

(4) "Fating and cooking utensils" means and 
includes any kitchen ware, tableware, glass- 
ware, cutlery, utensils, containers, or other 
equipment with which food or drink comes 
in contact during storage, preparation, or 
serving. 

(5) "Fmployee" means any person who han- 
dles food or drink during preparation or 
serving, or who comes in contact with any 
eating or cooking utensils, or who is em- 
ployed at any time in a room in which food 
or drink is prepared or served. 

(6) "Food" means any raw, cooked, or proc- 
essed edible substance, ice, beverage, or in- 
gredient used or intended for use or for sale 
in whole or in part for human consumption. 

(7) "Food stand" means and includes those 
food service establishments which prepare 
or serve foods and which do not provide 
seating facilities on the premises for cus- 
tomers. Fstablishments which only serve 
such items as dip ice cream, popcorn, can- 
died apples, or cotton candy are not in- 
cluded. 4w to the k+ek- »f public health 
significance). 

(8) "Hermetically sealed container" means a 
container designed and intended to be secure 
against the entry of micro-organisms and to 
maintain the commercial sterility of its con- 
tents after processing. 

(9) "Focal Health Director" means the ad- 
ministrative head of a local health depart- 
ment or his authorized representative. 

(10) "Mobile food unit" means a vehicle- 
mounted food service establishment de- 
signed to be readily moved. 

(11) "Person" means any individual, firm, as- 
sociation, organization, partnership, busi- 
ness trust, corporation, or company. 

(12) "Potentially hazardous food" means any 
food or ingredient, natural or synthetic, in a 
form capable of supporting the growth of 
infectious or toxigenic microorganisms, in- 
cluding Clostridium botulinum. This term 



NORTH CAROLINA REGISTER 



677 



PROPOSED RULES 



includes raw or heat treated foods of animal 
origin, raw seed sprouts, and treated foods 
of plant origin. The term docs not include 
foods which have a pll level of 4.6 or below 
or a water activity (Aw) value of 0.85 or less. 

(13) "Private club" means a private club as 
defined in G.S. 130A-247(2). awKtebfek- 
mont which maintains selective membership, 
is operated by t-he membership, a«4 is Ret- 
profit oriented. 

(14) "Pushcart" means a self-propelled or 
nonself-propelled vehicle on which food or 
drink may be prepared, handled, or served. 

(15) "Responsible person" means the individ- 
ual present in a food service establishment 
who is the apparent supervisor of the food 
service establishment at the time of in- 
spection. If no individual is the apparent 
supervisor, then any employee is the re- 
sponsible person. 

( 16) "Restaurant" means all establishments and 
operations, including drink stands, where 
food is prepared or served at wholesale or 
retail for pay or, any other establishment or 
operation where food is prepared or served 
that is subject to the provisions of G.S. 
130A-24S. 44w to- the k*4f el public h e alth 
significanc e . The term does not include es- 
tablishments which only serve such items as 
dip ice cream, popcorn, candied apples, or 
cotton candy. 

(17) "Sanitarian" means a qualified person au- 
thorized to represent the Department of 
I hi man Resources Pnvironment, Health 
and Natural Resources on the local or state 
level in making inspections pursuant to state 
laws and rules. 

(18) "Sanitize" means the approved bactericidal 
treatment by a process which provides 
enough accumulative heat or concentration 
of chemicals for enough time to reduce the 
bacterial count, including pathogens, to a 
safe level on utensils and equipment. 

(19) "Sewage" means the liquid and solid hu- 
man body waste and liquid waste generated 
by water-using fixtures and appliances, in- 
cluding those associated with foodhandhng. 
The term does not include industrial process 
wastewater or sewage that is combined with 
industrial process wastewater. 

(20) "Single service" means cups, containers, 
lids, closures, plates, knives, forks, spoons, 
stirrers, paddles, straws, napkins, wrapping 
materials, toothpicks, and similar articles in- 
tended for one-time, one person use and 
then discarded. 

(21) "Temporary food or drink stand" means 
and includes those food or drink stands 



which operate for a period of twe woolen 15 
days or less, as in connection conjunction 
with a fair, carnival, circus, public exhibi- 
tion, or other similar gathering. 
(22) "Temporary restaurant" means a restau- 
rant, as defined in Paragraph (16) of this 
Rule, that operates for a period of tw» 
weeks 15 days or less, as in connection con- 
junction with a fair, carnival, circus, public 
exhibition, or other similar gathering. 

Statutory Authority G.S. J30A-248. 

.0444 PERMITS 

(*) N» person shall operate a rootaurant, t e rn 
porary restaurant , food stand, drink stand, ef 
temporary food Bf drink stand within the Stat e 
»f North Carolina who does ft** possess a» tm- 
rovokod permit from the Department »f Human 
Resources. 

(a) fb} No permit to operate shall be issued to 
a person until a sanitary survey by a sanitarian 
shows that the establishment complies with this 
Section. 

(b) Upon transfer of ownership of an existing 
food service establishment, an authorized sanita- 
rian shall complete a sanitary survey, jf the es- 
tablishment satisfies all the requirements of the 
rules, a permit shall be issued. If the establish- 
ment does not satisfy all the requirements of the 
rules, a permit shall not be issued. However, if 
a sanitarian determines that the noncompliant 
items are only construction or equipment prob- 
lems that do not represent a threat to the public 
health, a transitional permit may be issued. The 
transitional permit shall expire 60 days after the 
date of issuance, unless suspended or revoked 
before that date, and cannot be renewed. Upon 
expiration of the transitional permit, the owner 
or operator shall have corrected the noncompli- 
ant items and obtained a permit, or the food 
service establishment cannot continue to operate. 

(e) A permit issued te- »«** person is ftet- trans 
f e rabl e t» another person. 

(c) Sanitarians may impose conditions on the 
issuance of a permit or transitional permit that 
makes the permit subject to one or more of the 
following limitations: 

(1) The number of seats or persons served. 

(2) The categories of food served. 
Schedules in completing small con- 

struction items. 



ill 

Mi 

[5] 
(61 
121 



To modify or maintain wells or springs 
used as a water supply. 
Dual use of facilities. 
Shared solid waste and can wash facilities. 



Continuation of contractual arrangements 
upon which basis the permit was issued. 



678 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(81 

121 
(d) 



Submission and approval of plans for re- 
novation. 

Anv other condition necessary for a food 
service operation to remain in compliance 
with this Section. 



A permit is issued by and inspections are 
made by local and state sanitarians, who are au- 
thorized representatives of the Department of 
Environment, Health and 



Human Resources 

Natural Resources. 

fe} A permit shall be immediately revoked m 
accordance with G.S. 130A 23(d) fo? failure ef 
the facility te- maintain a minimum grade ef Or 
A permit may otherwise be suspended ef revoked 
m accordance with 130A 23. A- h*w permit t» 
operate shall be issued only after the establish 
ment k*» been rer . urveyed by a sanitarian »f>4 

^^IHTI cTT CT^HTTT ^^^T^T mTT* ! ^.T-T. ITT I T . t TT^J r^^^^^T^^T^T 

w+11 be conducted within » reasonable length ef 
time after the request » mad e by the operator. 

(e) if a permit has been suspended or revoked^ 
the suspension shall he lifted or a new permit 
shall be issued only after the establishment has 
been resurvcyed by a sanitarian and found to 
comply with this Section. This resurvev shall be 
conducted within a reasonable length of time af- 
ter the request is made by the operator. 

Statutory Authority G.S. 130A-248. 
SECTION .2500 - PUBLIC SWIMMING POOLS 

.2501 PREAMBLE 

Whereas the North Carolina General Assembly 
has enacted Part 10 of .Article 8 of G.S. 130A - 
Public Swimming Pools - which requires the 
Commission for Health Services to establish 
construction and operation requirements for 
public swimming pools in North Carolina; and 
whereas Senate Bill 386 requires the Commission 
for Health Services to establish such require- 
ments by February 1, 1990; and whereas the 
Commission finds that additional time is needed 
to develop comprehensive rules in this area, now, 
therefore, be it resolved that the Commission for 
Health Services adopts the rules of this Section 
as an interim measure to assure implementation 
of a public swimming pool program on February 
1, 1990. 

Statutory Authority S.L. 1989, c. 577. 

.2502 DEFINITIONS 

The following definitions shall apply through- 
out this Section: 
(1) Department means the Department of En- 
vironment, Health, and Natural Resources. 



(2) Public swimming pool means public 
swimming pool as defined in G.S. 130A-280. 

(3) Remodeled means renovations requiring 
disruption of the pool shell or deck or re- 
placement of major components of the pool 
hydraulic system. Remodeled does not in- 
clude repairs. 

(4) Repair means replacement of indi%idual 
components of the hydraulic equipment 
such as pumps, filters, and drain covers. 

Statutory Authority S.L. 1 989, c. 577. 

.2503 PUBLIC SWIMMING POOL 
OPERATION PERMITS 

(a) No public swimming pool shall commence 
or continue operation on or after February 1, 
1990 unless the owner or operator has an opera- 
tion permit issued by the Department for each 
public swimming pool. Unless suspended or re- 
voked, the operation permit shall be valid for the 
period of operation specified in the application 
but in no event shall it be valid for more than 12 
months. For public swimming pools which are 
constructed or remodeled after February 1, 1991, 
no operation permit shall be issued unless plans 
and specifications prepared by a registered pro- 
fessional engineer have been approved by the 
Department. Compliance with the design and 
construction requirements in Rule .2505(a) of 
this Section and approval of plans and specifica- 
tions shall not be required for public swimming 
pools constructed or remodeled prior to Febru- 
ary 1, 1991. 

(b) For public swimming pools which are re- 
paired after February 1, 1991, all repairs and re- 
pair components shall comply with Rule .2505(a) 
of this Section and shall be approved by the De- 
partment prior to installation. Engineered plans 
and specifications may be required for repairs. 

(c) If a local board of health has adopted rules 
prior to July 5, 1989 that establish public swim- 
ming pool standards, public swimming pools in 
that county or district must meet those standards 
until February 1, 1992. On or after February 1, 
1992, all public swimming pools must meet these 
rules; however, public swimming pools permitted 
under local rules prior to February 1, 1992 shall 
not be required to meet the design and con- 
struction requirements of these rules. 

(d) A separate application for an operation 
permit must be submitted for each public swim- 
ming pool. To apply for an annual operation 
permit, the owner or operator shall submit the 
following information on a form provided by the 
Department to the Department: 

(1) the owner's name, address, and phone 
number; 



NORTH CAROLINA REGISTER 



679 



PROPOSED RULES 



(2) the operator's name, address, and phone 
number; 

(3) street address of the public swimming 
pool; 

(4) the physical location of the public swim- 
ming pool; 

(5) type of public swimming pool; 

(6) construction date; 

(7) proposed operating date; 

(8) type of sanitizer; 

(9) other pertinent information. 

Statutory Authority S.L. 1989, c. 577. 

.2504 INSPECTIONS 

Each public swimming pool shall be inspected 
by the Department at least once during the pe- 
riod of operation to determine compliance with 
the rules of this Section. 

Statutory Authority S.L. 19S9, c. 577. 

.2505 DESIGN AND CONSTRUCTION 
STANDARDS 

(a) Public swimming pools shall be designed 
by a registered professional engineer in accord- 
ance with National Spa and Pool Institute, Min- 
imum Standards for Public Swimming Pools; 
Public Health Sen ice, Suggested Health and 
Safety Guidelines for Public Spas and Hot Tubs; 
or the American Public Health Association, 
Public Swimming Pools: Recommended Regu- 
lations for Design and Construction. Operation 
and Maintenance, which is hereby adopted by 
reference in accordance with G.S. 150B- 14(c). 

(b) Prior to approval by the Department, plans 
and specifications shall be submitted to the De- 
partment and shall include verification by the 
design engineer that the plans and specifications 
comply with the requirements in Paragraph (a) 
of this Rule. 

(c) Prior to issuance of the operation permit, 
the owner shall submit to the local health de- 
partment a statement signed by a registered pro- 
fessional engineer stating that construction is 
complete and in accordance with approved plans 
and specifications and approved modifications. 
Periodic observations of construction and a final 
inspection for design compliance by the certifying 
registered professional engineer or his represen- 
tative shall be required for this statement. The 
statement shall be affixed with the registered 
professional engineer's seal. 

Statutory Authority S.L. 1989, c. 577. 

.2506 WATER QUALITY STANDARDS 



Swimming pool water quality shall be main- 
tained in accordance with the following: 

(1) The chemical quality of the water shall be 
maintained in an alkaline condition at all 
times with the pH between 7.2 and 8.2 and 
the total alkalinity between 80 and 1 50 parts 
per million. 

(2) The clarity of the water shall be maintained 
such that the main drain grate is readily vis- 
ible from the pool deck at all times. 

(3) Disinfection shall be provided for all pools 
by a chemical or other process that has been 
accepted by the Department and meets the 
criteria listed as follows: 

(a) Registered with the U.S. Environmental 
Protection Agency as a disinfectant or di- 
sinfectant process for pool water or pota- 
ble water. 

(b) Provides a residual effect in the pool water 
which can be measured by simple portable 
field test equipment. 

(c) Compatible when used in conjunction 
with other chemicals normally used in 
pool water treatment. 

(d) Will not impart toxic qualities to the pool 
water in excess of that which occurs dur- 
ing proper chlorination procedures when 
used as directed. 

(e) Will not impart any immediate or cumu- 
lative adverse physiological effects to pool 
bathers when used as directed. 

(f) Will not produce any undue safety hazard 
when stored or used as directed. 

(g) Will not damage or cause excessive wear 
of pool components or equipment. 

(4) When chlorine is used as the disinfectant, 
a free chlorine residual of at least 1.0 part 
per million (ppm) but no more than 4 ppm 
and a pH of between 7.2 and 7.8 shall be 
maintained throughout the pool whenever 
it is open or in use. A pool may be operated 
with a pH as high as 8.2 provided that a free 
chlorine residual above 1.5 parts per million 
is maintained. Pools which use chlorine as 
the disinfectant must be stabilized with 
cyanuric acid except at indoor pools or 
where it can be shown that cyanuric acid is 
not necessary to maintain a stable free chlo- 
rine residual. Normal cyanuric acid level 
must be between 25 and 60 parts per mil- 
lion. A pool may be operated with cyanuric 
acid levels as high as 60 to 100 parts per 
million provided that a free chlorine residual 
of at least 2.0 parts per million is main- 
tained. 

(5) \\ nen bromine or compounds of bromine 
are used as the disinfectant, a free bromine 
residual of at least 1.5 parts per million and 



680 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



a pi I of between 7.2 and 8.2 must be main- 
tained throughout the pool whenever it is 
open or in use. 
(6) Automatic chemical feeders that arc NSF 
listed shall be used when chlorine, bromine, 
or compounds of bromine are used as a di- 
sinfectant. Feeders shall be installed in ac- 
cordance with NSF standards. 

Statutory Authority S.L. I9S9, c. 577. 

.2507 REVOCATION OF PERMITS 

The Department may suspend or revoke per- 
mits in accordance with G.S. 130A-23. 

Statutory Authority S.L. 1989, c. 577. 

.2508 APPEALS 

Appeals shall be made in accordance with G.S. 
150B. 

Statutory Authority S.L. J9S9, c. 577. 

SUBCHAPTER I0G -SOLID WASTE 
MANAGEMENT 

SECTION .1000 - MEDICAL WASTE 
MANAGEMENT 

.1001 DEFINITIONS 

For the purpose of the Section, the following 
definitions apply: 

(1) "Blood and body fluids" means liquid 
blood, scrum, plasma, other blood products, 
spinal fluid, dialysatc, pleural and peritoneal 
fluids. 

(2) "Class A Medical Waste" means blood and 
body fluids in individual containers in vol- 
umes greater than 20 ml., microbiological 
waste, and pathological waste that have not 
been treated pursuant to Rule .1007 of this 
Section. 

(3) "Class B Medical Waste" means blood and 
body fluids in individual containers in vol- 
umes of 20 ml or less and sharps in puncture 
resistant containers. 

(4) "Generating facility" means a hospital, 
clinic, funeral home, laboratory, or other fa- 
cility which generates medical waste. 

(5) "Medical waste" means any solid waste 
which is generated in the diagnosis, treat- 
ment, or immunization of human beings or 
animals, in research pertaining thereto, or in 
the production or testing of biologjcals, but 
does not include hazardous waste, radioac- 
tive waste, household waste as defined in 40 
Code of Federal Regulations 261.4(b)(1) in 
effect on 1 July 1989, or those substances 



excluded from the definition of "solid 
waste" in this Section. 

(6) "Microbiological waste" means cultures 
and stocks of infectious agents, including but 
not limited to specimens from medical, pa- 
thological, pharmaceutical, research, com- 
mercial, and industrial laboratories. 

(7) "Pathological waste" means human tissues, 
organs and body parts, and the carcasses and 
body parts of all animals that were exposed 
to pathogens in research, were used in the 
production of biologicals or in vivo testing 
of pharmaceuticals, or that died of known 
or suspected disease transmissible to hu- 
mans. 

(8) "Sharps" means and includes needles, syr- 
inges with attached needles, capillary tubes, 
slides and cover slips, and scalpel blades. 

(9) "Treatment" as defined in 130A-309.26 
(a)(2). 

Statutory Authority G.S. 1 30 A- 309. 26. 

.1002 GENERAL REQUIREMENTS FOR 
MEDICAL WASTE 

(a) Medical waste is subject to all applicable 
rules in 10 NCAC 10G. 

(b) Sharps shall be placed directly into a rigid 
and puncture-resistant container upon gener- 
ation. Removal of sharps from containers for 
any purpose prior to treatment or disposal in a 
sanitary landfill is prohibited. 

(c) All medical waste transported from the 
generating facility for off-site treatment is subject 
to the requirements of Class A Medical Waste. 

Statutory Authority G.S. I30A-309.26. 

.1003 GENERAL REQUIREMENTS FOR 
CLASS A MEDICAL WASTE 

(a) Class A Medical waste shall be treated prior 
to disposal. Acceptable methods of treatment 
are as follows: 

(1) blood and body fluids - Incineration or 
sanitary sewage systems; 

(2) microbiological waste - Incineration, 
steam sterilization, or chemical treatment; 

(3) pathological wastes - Incineration. 

(b) Other methods of treatment shall require 
approval by the Division. 

(c) Class A medical waste shall be stored in a 
manner that: 

(1) prevents leakage of the contents of the 
package; and 

(2) permits access only to authorized person- 
nel. 

Statutory Authority G.S. I30A-309.26. 



NORTH CAROLINA REGISTER 



681 



PROPOSED RULES 



.1004 REQUIREMENTS FOR GENERATORS 
OF (LASS A MEDICAL WASTE 

A person who generates Class A medical waste 
that is not treated at the generating facility shall 
meet the following requirements with respect to 
such waste: 

(1) Class A medical waste other than sharps 
shall be packaged in a minimum of two 3- 
mil. polyethylene equivalent bags, and 
placed in a 175-pound, burst strength, sin- 
gle-walled corrugated fibcrboard box which 
is rigid and leak resistant. 

(2) Class A medical waste shall be stored in a 
manner that maintains the integrity of the 
packaging. 

(3) Each package of Class A medical waste 
shall be labeled with a water-resistant iden- 
tification tag containing the universal bioha- 
zard symbol. 

(4) Each package of Class A medical waste 
shall be marked with the following informa- 
tion: 

(a) the generator's name, address, and tele- 
phone number: 

(b) the transporter's name, address, and tele- 
phone number; 

(c) storage facility name, address, and tele- 
phone number, when applicable; and 

(d) treatment facility name, address and tele- 
phone number; and 

(e) date of shipment. 

(5) Records of Class A medical wastes shall be 
maintained for each shipment and shall in- 
clude the information listed in this Para- 
graph. This information shall be maintained 
at the generating facility for no less than 
three years. This requirement shall not ap- 
ply to persons who generate less than 50 
pounds of Class A medical waste per month. 

(a) amount of waste by number of packages 
(piece count); 

(b) date shipped off site; 

(c) name of transporter; 

(d) name of storage and/or treatment facility. 

(6) A plan to ensure proper management of 
Class A medical waste shall be prepared and 
maintained at the facility. 

Statutory Authority G.S. I30A-309.26. 

.1005 REQLIREMENTS FOR TRANSPORTERS 
OF CLASS A MEDICAL WASTE 

A person who transports Class A medical waste 
that is not treated at the generating facility shall 
meet the following requirements with respect to 
such waste: 



(1) Class A medical waste shall be transported 
in a manner that prevents leakage of the 
contents of the package. 

(2) The integrity of the package shall be main- 
tained at all times. 

(3) The labeling and marking of the package 
shall be maintained at all times. 

(4) The universal biohazard symbol shall be 
displayed on all transportation vehicles, in 
accordance with Department of Transporta- 
tion Standards and 49 CFR 172 Subpart F. 

(5) Class A medical waste shall be delivered to 
a permitted storage or treatment facility 
within seven calendar days of the date of 
shipment from the generator. 

(6) Refrigeration at an ambient temperature 
between 35 and 45 degrees Fahrenheit shall 
be provided for Class A medical waste that 
will not be delivered for treatment within 
seven calendar days. 

(7) A plan shall be prepared and maintained in 
each vehicle used in the transporting of Class 
A medical waste. The operator of each ve- 
hicle shall be knowledgeable of the plan. 

(8) Vehicles used for the transportation of Class 
A medical waste shall be thoroughly cleaned 
and disinfected with a mycobacteriocidal di- 
sinfectant before being used for any other 
purpose and in the event of leakage from 
packages. 

(9) Vehicles are prohibited from transporting 
any material other than solid waste with 
Class A medical waste. 

Statutory Authority G.S. 130A-309.26. 

.1006 REQUIREMENTS FOR STORAGE OF 
CLASS A MEDICAL WASTE 

A person who stores Class A medical waste 
shall meet the following requirements: 

(1) Class A medical waste shall be stored in a 
manner that prevents leakage of the contents 
of the package. 

(2) The integrity of the package shall be main- 
tained at all times. 

(3) The labeling and marking of the package 
required in Rule .1004 of this Section shall 
be maintained at all times. 

(4) Class A medical waste shall not be stored 
longer than seven calendar days from the 
date of shipment from the generator unless 
the Class A Medical Waste is refrigerated at 
an ambient temperature between 35 and 45 
degrees Fahrenheit. 

(5) Areas used to store Class A medical waste 
shall permit access only authorized person- 
nel. 



6S2 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(6) All areas used to store Class A medical 
waste shall be kept clean. Neither carpets 
nor floor coverings with seams shall be used 
in storage areas. Vermin and insects shall 
be controlled. 

(7) All floor drains shall discharge directly to 
an approved sanitary' sewage system. Ven- 
tilation shall be provided and shall discharge 
so as not to create nuisance odors. 

(8) A plan shall be prepared, maintained and 
updated as necessary to ensure continued 
proper management of Class A medical 
waste at the facility. 

Statutory Authority G.S. I30A-309.26. 

.1007 REQUIREMENTS FOR TREATMENT OF 
CLASS A MEDICAL WASTE 

A person who treats Class A medical waste shall 
meet the following specific requirements for each 
type of treatment in addition to the requirements 
in Rule .1003 of this Section: 

(1) Steam Sterilization: 

(a) Steam under pressure shall be provided to 
maintain a minimum temperature of 250 
degrees Fahrenheit for 45 minutes at 15 
pounds per square inch of gauge pressure 
during each cycle. 

(b) The steam sterilization unit shall be pro- 
vided with a chart recorder which accu- 
rately records time and temperature of 
each cycle. 

(c) The steam sterilization unit shall be pro- 
vided with a gauge which indicates the 
pressure of each cycle. 

(d) Monitoring under conditions of full load- 
ing for effectiveness of treatment shall be 
performed no less than once per week 
through the use of biological indicators 
or other methods approved by the Divi- 
sion. 

(e) Class A medical waste shall not be dis- 
posed of unless monitoring as required in 
Paragraph (l)(b) of this Rule confirms the 
effectiveness of treatment. 

(f) A log of each test of effectiveness of treat- 

ment performed shall be maintained and 
shall include the type of indicator used, 
date, time, and result of test. 

(g) Each package or container of Class A 
medical waste to be treated shall be pro- 
vided with tape which will indicate if op- 
erational temperatures are reached. 

(h) Thermo-scnsitive indicator tape required 
in Paragraph (l)(g) of this Rule shall re- 
main attached to all packages and con- 
tainers of treated waste shipped for 
ultimate disposal. 



(i) Refrigeration at an ambient temperature 
between 35 and 45 degrees Fahrenheit 
shall be maintained for Class A medical 
waste not treated within seven calendar 
days of the date of shipment from the 
generator. 

(j) Class A medical waste shall be stored prior 
to treatment for no more than seven cal- 
endar days after receipt. 

(k) Class A medical waste shall be stored no 
longer than five calendar days after treat- 
ment. 

(1) Areas used to store Class A medical waste 
shall permit access only to authorized 
personnel. 

(m) All areas used to store Class A medical 
waste shall be kept clean. Neither carpets 
nor floor coverings with seams shall be 
used in storage areas. Vermin and insects 
shall be controlled. 

(n) Prior to treatment, all Class A medical 
waste shall be confined to the storage area. 

(o) All floor drains shall discharge directly to 
an approved sanitary sewage system. 
Ventilation shall be provided and shall 
discharge so as not to create nuisance 
odors. 

(p) A plan shall be prepared, maintained and 
updated as necessary to ensure continued 
proper management of Class A medical 
waste at the facility. 

(q) Records of Class A medical waste shall 
be maintained for each shipment and shall 
include the information listed in this Par- 
agraph. This information shall be main- 
tained at the treatment facility for no less 
than three years. This requirement shall 
not apply to Class A medical waste that 
is treated at the generating facility, 
(i) name of generator; 
(ii) date received; 

(iii) amount of waste received by number 
of packages (piece count) from each gen- 
erator; 
(iv) date treated. 
(2) Incineration: 

(a) Class A medical waste shall be subjected 
to a burn temperature of not less than 
1600 degrees Fahrenheit in the primary 
chamber. Gases generated by the com- 
bustion shall be subjected to a temper- 
ature of not less than 1850 degrees 
Fahrenheit for a period of not less than 
two seconds. 

(b) Interlocks or other process control devices 
shall be provided to prevent operation of 
the incinerator until the conditions in 
Paragraph (2)(a) of this Rule can be 



NORTH CAROLINA REGISTER 



683 



PROPOSED RULES 



achieved. Automatic auxiliary' burners 
which are capable, excluding the heat 
content of the wastes, of independently 
maintaining the secondary chamber tem- 
perature at the minimum of 1850 degrees 
Fahrenheit shall be provided. 

(c) Continuous monitoring and recording of 
primary and secondary chamber temper- 
atures shall be performed. Monitoring 
data shall be maintained for a period of 
three years. 

(d) /Ml combustible waste shall be converted 
by the incineration process into ash that 
is not recognizable as to its former char- 
acter. 

(e) An Air Quality Permit shall be obtained 
from the Division of Environmental 
Management prior to operation. 

(f) Refrigeration at an ambient temperature 
between 35 and 45 degrees Fahrenheit 
shall be provided for Class A medical 
waste not treated within seven calendar 
days of the date of shipment from the 
generator. 

(g) Areas used to store Class A medical waste 
shall permit access only to authorized 
personnel. 

(h) All areas used to store Class A medical 
waste shall be kept clean. Neither carpets 
nor floor coverings with seams shall be 
used in storage areas. Vermin and insects 
shall be controlled. 

(i) Class A medical waste shall not be stored 
for more than seven calendar days after 
receipt. 

(j) Prior to treatment, all Class A medical 
waste shall be confined to the storage area. 

(k) All floor drains shall discharge directly to 
an approved sanitary sewage system. 
Ventilation of storage area shall be pro- 
vided and shall discharge so as not to cre- 
ate nuisance odors. 

(1) A plan shall be prepared, maintained and 
updated as necessary to ensure proper 
management of Class A medical waste at 
the facility. 

(m) Records of Class A medical waste shall 
be maintained for each shipment and shall 
include the information listed in this Par- 
agraph. This information shall be main- 
tained at the treatment facility for no less 
than three years. This requirement shall 
not apply to Class A medical waste that 
is treated at the generating facility, 
(i) name of generator; 
(ii) date received; 



(iii) amount of waste received by number 
of packages (piece count) from each gen- 
erator; 
(iv) date treated. 

(n) A representative sample of 250 milliliters 
of ash from the ash discharge or the ash 
discharge conveyor shall be collected once 
every eight hours of operation of a con- 
tinuously fed incinerator and once every 
24 hours of operation of a batch fed in- 
cinerator. Samples collected after every 
1000 hours of operation, or quarterly, 
whichever occurs more frequently, shall 
be thoroughly mixed and seven random 
portions of equal volume shall be com- 
posited into one sample for laboratory 
analysis. This sample shall be tested in 
accordance with provisions of Rule 
.0103(e) of this Subchapter and submitted 
to the N.C. Solid Waste Section for eval- 
uation as to final disposal. 

(o) A log shall be kept documenting ash 
sampling, which shall include the date and 
time of each sample collected; the date, 
time, and identification number of each 
composite sample; and the results of the 
analyses, including laboratory identifica- 



tion. 



(P) 



(q) 



(b) 



Records of stack testing as prescribed in 
the Air Quality Permit shall be main- 
tained at the facility. 

Existing generating facilities that only treat 
Class A medical waste generated at their 
facility are not subject to Paragraphs 
(2)(a), (b), and (c) until January 1, 1995. 
(3) Chemical Treatment: 
(a) Approval for treatment must be obtained 
from the Division. 

Request for approval must be substanti- 
ated by results of demonstrated effective- 
ness of the chemical to treat the specific 
microbiological agcnt(s) of concern for the 
waste disposed. Consideration must be 
given to such factors as temperature, time 
of contact, pi I, concentration and the 
presence and state of dispersion, penetra- 
bility and reactivity of organic material at 
the site of application. 
A written plan must be maintained at the 
facility and units of the facility as neces- 
sary to ensure consistent procedures are 
used to treat the waste. 

Refrigeration at an ambient temperature 
between 35 and 45 degrees Fahrenheit 
shall be maintained for Class A waste not 
treated within seven calendar days of the 
date of shipment from the generator. 



(c) 



(d) 



684 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(e) Class A medical waste shall be stored prior 
to treatment for no more than seven cal- 
endar days after receipt. 

(f) Class A medical waste shall be stored no 
longer than five calendar days after treat- 
ment. 

(g) Areas used to store Class A medical waste 
shall permit access only to authorized 
personnel. 

(h) All areas used to store Class A medical 
waste shall be kept clean. Neither carpets 
nor floor coverings with scams shall be 
used in storage areas. Vermin and insects 
shall be controlled. 

(i) Prior to treatment, all Class A medical 
waste shall be confined to the storage area. 

(j) All floor drains shall discharge directly to 
an approved sanitary sewage system. 
Ventilation shall be provided and shall 
discharge so as not to create nuisance 
odors. 

(k) A plan shall be prepared, maintained and 
updated as necessary to ensure continued 
proper management of Class A medical 
waste at the facility. 

(1) Records of Class A medical waste shall be 
maintained for each shipment and shall 
include the information listed in this Par- 
agraph. This information shall be main- 
tained at the treatment facility for no less 
than three years. This requirement shall 
not apply to Class A medical waste that 
is treated at the generating facility, 
(i) name of generator; 
(ii) date received; 

(iii) amount of waste received by number 
of packages (piece count) from each gen- 
erator; 
(iv) date treated. 

Statutory Authority G.S. 130A-309.26. 

.1008 REQUIREMENTS FOR CLASS B 
MEDICAL WASTE 

(a) Class B medical waste shall be packaged 
and stored in the following manner: 

(1) Class B medical waste shall be packaged 
in a minimum of two 3-mil. polyethylene 
equivalent bags and placed in a 
175-pound, burst -strength, single-walled 
corrugated fibcrboard box which is rigid 
and leak resistant; 

(2) Class B medical waste shall be stored in a 
manner that prevents leakage of the con- 
tents, maintains the integrity of the pack- 
age, and permits access only to authorized 
personnel. 



(b) Class B medical waste is subject to all ap- 
plicable rules in 10 NCAC 10G. 

Statutory Authority G.S. 130A-309.26. 

****************** 



iV otice is hereby given in accordance with G.S. 
1 SOB- 12 that the Commission for Mental Health, 
Mental Retardation and Substance Abuse Services 
intends to adopt rule(s) cited as 10 NCAC I8L 
.1501 - .1525; and amend rule(s) cited as 10 
NCAC 45 H .0202. 

1 he proposed effective date of this action is Fe- 
bruary 1, 1990. 

1 he public hearing will be conducted at 1 1:30 
a.m. on November 8, 1989 at Holiday Inn State 
Capitol, 320 Hillsborough Street, Raleigh, N.C. 
27603. 

(comment Procedures: Any interested person 
mav present his' her comments by oral presentation 
or by submitting a written statement. Persons 
wishing to make oral presentations should contact 
Julie Burton, Division of Mental Health, Mental 
Retardation and Substance Abuse Services, 325 
N. Salisbury Street, Raleigh, N.C. 27611, (919) 
733-4774 by November 8, 1989. The hearing re- 
cord will remain open for written comments from 
October 2, 1989 through November 8, 1989. 
Written comments must be sent to the above ad- 
dress and must state the rule(s) to which the 
comments are addressed. Fiscal information on 
these rules is also available from the same address. 

CHAPTER 18 - MENTAL HEALTH: OTHER 
PROGRAMS 

SUBCHAPTER I8L - PROGRAM COMPONENT 
OPERATIONAL STANDARDS 

SECTION .1500 - EARLY INTERVENTION 
SERVICES PROCEDURE SAFEGUARDS 

.1501 PURPOSE 

This Section sets forth the procedural safeguards 
required by Public Law 99-457, The Education 
of the Handicapped Amendments of 1986 (Part 
H of the Education of the Handicapped Act). 
This Act requires states which utilize funds ap- 
propriated under this Act to establish compre- 
hensive, multidisciplinary systems of early 
intervention services for infants and toddlers with 
or at risk for developmental disabilities, delays, 
or atypical development, and their families. This 



NORTH CAROLINA REGISTER 



685 



PROPOSED RULES 



Section is designed to protect the rights of chil- 
dren and their families involved in the early in- 
tervention system. 

Statutory Authority G.S. I43B-147; 150B-I(d); 
20 U.S.C. Sections 1401 et. seq., 1471 el.scq.. 

.1502 SCOPE 

This Section applies to those early intervention 
services that are available through the area pro- 
grams and contract agencies. 

Statutory Authority G.S. I43B-147; 150B-l(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.1503 DEFINITIONS 

(a) As used in this Section, the following terms 
shall have the meanings specified in Section 
303.401 of Subpart E of Part 303 of Title 34 of 
the Code of Federal Regulations: 

(1) "Consent"; 

(2) "Native language"; 

(3) "Personally identifiable". 

This adoption by reference is in accordance with 
G.S. 150B- 14(c). 

(b) As used in this Section, the term "Early 
Intervention Services" shall have the meaning 
specified in Section 303.12 of Subpart A of Part 
303 of Title 34 of the Code of Federal Regu- 
lations. This adoption by reference is in accord- 
ance with G.S. 150B- 14(c). 

(c) As used in this Section, an eligible child is 
an infant or toddler with or at risk for develop- 
mental disabilities, delays, or atypical develop- 
ment as defined in 10 NCAC 14K .0103. This 
adoption bv reference is in accordance with G.S. 
1 SOB- 14(c)' 

Statutory Authority G.S. 143B-147; 150B-l(d); 
20 U.S.C. Sections 1401 et. seq., 1471 el.scq.. 

.1504 OPPORTUNITY TO EXAMINE 
RECORDS 

Area programs and contract agencies shall 
comply with Section 303.402 of Subpart E of 
Part 303 of Title 34 of the Code of Federal Reg- 
ulations relating to the right of the parents of an 
eligible child to examine records. This adoption 
by reference is in accordance with G.S. 
150B- 14(c). 

Statutory Authority G.S. I43B-147; 150B-l(d); 
20 U.S.C. Sections 1401 el. seq., 1471 et.seq.. 

.1505 PRIOR NOTICE; NATIVE LANGUAGE 

Area programs and contract agencies shall 
comply with Section 303.403 of Subpart E of 
Part 303 of Title 34 of the Code of Federal Reg- 



ulations relating to the requirement of prior no- 
tice to parents of an eligible child in the parents' 
native language. This adoption by reference is 
in accordance with G.S. 150B- 14(c). 

Statutory Authority G.S. 143B-147; 150B-l(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 



PARENT CONSENT 

programs and contract 



.1506 

Area programs and contract agencies shall 
comply with Section 303.404 of Subpart E of 
Part 303 of Title 34 of the Code of Federal Reg- 
ulations relating to the requirement of parental 
consent. The period of reasonable time refer- 
enced in 303.403(a) shall be construed to be no 
less than two weeks. This adoption by reference 
is in accordance with G.S. 150B- 14(c). 

Statutory Authority G.S. 143B-147; 150B-/(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 



SURROGATE PARENTS 

programs and contract 



.1507 

Area programs and contract agencies shall 
comply with Section 303.405 of Subpart F of 
Part 303 of Title 34 of the Code of Federal Reg- 
ulations relating to surrogate parents. This 
adoption bv reference is in accordance with G.S. 
150B- 14(c)' 



Statutory Authority G.S. 143B-147; 150B-I(d); 
T, .S.C. Sections 1401 et. seq.. 1471 et.seq.. 



20 U.. 



.1508 EARLY INTERVENTION SERVICES 

Area programs and contract agencies shall 
comply with Section 303.12 (b) through (e) of 
Subpart A of Part 303 of Title 34 of the Code of 
Federal Regulations relating to early intervention 
services. This adoption bv reference is in ac- 
cordance with G.S. 150B- 14(c). 

Statutory Authority G.S. 143B-147; 1 SOB- 1(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.1509 ADMINISTRATIVE RESOLUTION OF 
COMPLAINTS RIGHT; MEDIATION 

Parents of an eligible child shall have the right 
to a timely administrative resolution of any 
complaints concerning an area program's or 
contract agency's proposal or refusal to initiate 
or change the identification, evaluation or place- 
ment of the child, or concerning the provision of 
appropriate early intervention services to the 
child and the child's family. The parents of an 
eligible child shall also have the right to medi- 
ation of such complaints. The administrative 
resolution and/or mediation of complaints shall 
be as set forth in this Section. 



6S6 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



Statutory Authority G.S. I43B-147; I SOB- 1(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.1510 ADVISING PARENTS OF 

AVAILABILITY OF COMPLAINT 
RESOLUTION 

Whenever an area program or contract agency 
becomes aware that the parents of an eligible 
child disagree with any decision regarding early 
intervention services for their child, the area pro- 
gram or contract agency, whichever is appropri- 
ate, shall immediately advise the parents 
regarding the availability of and procedure for 
requesting complaint resolution under this Sec- 
tion. 

Statutory Authority G.S. I43B-147; ISOB-l(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.151 1 WRITTEN REQUEST FOR COMPLAINT 
RESOLUTION 

A request by parents of an eligible child for ad- 
ministrative resolution and/or mediation of a 
complaint shall be in writing and sent to the Di- 
rector of the area program in which the eligible 
child is receiving services. 

Statutory Authority G.S. 143B-147; 1 SOB- 1(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.1512 CONTENT OF REQUEST FOR 
COMPLAINT RESOLUTION 

A request by parents of an eligible child for ad- 
ministrative resolution and or mediation of a 
complaint shall contain the following: 

(1) name and address of the child: 

(2) name and address of the parent(s); 

(3) name and address of the area program or 
contract agency against whom the complaint 
is made; 

(4) a statement of facts describing in sufficient 
detail the nature of the complaint; 

(5) the signature of the complaining parcnt(s) 
and the date of signing; and 

(6) whether the parent desires mediation prior 
to the administrative resolution of his com- 
plaint. 

Statutory Authority G.S. 143B-/47; ISOB-l(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.1513 SCHEDULING ADMINISTRATIVE 
PROCEEDINGS 

Upon receipt of written request for administra- 
tive complaint resolution pursuant to Rule .1512 
of this Section, the Director of the area program 
in which the eligible child is receiving services 
shall schedule an administrative proceeding in 
accordance with the requirements of this Section. 



The parents shall be notified in writing of the 
date, time and location of the proceeding no later 
than seven calendar days prior to the hearing by 
the area director. The hearings must be sched- 
uled at a time and place that is reasonably con- 
venient to the parents. 

Statutory Authority G.S. 143B-I47; ISOB-l(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.1514 APPOINTMENT AND QUALIFICATIONS 
OF IMPARTIAL PERSON 

An impartial person shall be appointed by the 
area director to serve as a hearing officer for im- 
plementation of the administrative complaint re- 
solution process. Compliance with Section 
303.421 of Subpart E of Part 303 of Title 34 of 
the Code of Federal Regulations relating to the 
qualifications of an impartial person is required. 
This adoption by reference is in accordance with 
G.S. 1 SOB- 14(c). The impartial person must be 
selected from a list of hearing officers approved 
by the Deputy Director of the Developmental 
Disabilities Section of the Division of Mental 
Health, Developmental Disabilities and Sub- 
stance Abuse Services. The Division of Mental 
Health, Developmental Disabilities and Sub- 
stance Abuse Services shall provide a training 
program for the impartial hearing officers. 

Statutory Authority G.S. 143B-I47; 1S0B-I(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.1515 AUTHORITY AND RESPONSIBILITIES 
OF IMPARTIAL PERSON 

(a) The hearing officer shall have the powers 
listed in G.S. 150B-33, and in addition shall have 
the following authority: 

(1) to establish reasonable time limitations on 
the parties' presentations; 

(2) to disallow irrelevant, immaterial or re- 
petitive evidence; 

(3) to direct that additional evaluations of the 
child be performed; 

(4) to make findings of fact and conclusions 
of law relevant to the issues involved in 
the hearing; 

(5) to issue subpoenas for the attendance of 
witnesses or the production of documents; 
and 

(6) to specify the type and scope of the early 
intervention services to be offered the 
child, where the proposed services are 
found to be inappropriate. 

This adoption by reference of G.S. 150B-33 shall 
be in accordance with G.S. 150B- 14(c). 

(b) The hearing officer does not have the au- 
thority to: 



NORTH CAROLINA REGISTER 



687 



PROPOSED RULES 



(1) determine that only a specific program, 
specific early intervention staff person or 
specific service provider is appropriate for 
the pupil; or 

(2) determine noncompliance of state law and 
regulations. 

(c) The decision of the hearing officer shaLl be 
in writing and shall contain findings of fact, con- 
clusions of law and the reasons for the decision. 
The hearing officer shall mail a copy of the deci- 
sion to each party by certified mail, return receipt 
requested. 

(d) The hearing officer shall inform the parent 
that the parent may obtain a transcript of the 
hearing by paying the cost for a copy. If the 
hearing officer determines that the parent is indi- 
gent, a transcript shall be provided without cost. 

Statutory Authority G.S. 143B-147; ISOB-l(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.1516 PARENT RIGHTS IN ADMINISTRATIVE 
PROCEEDINGS 

Parents of an eligible child shall have the rights 
set forth in Section 303.422 of Subpart E of Part 
303 of Title 34 of the Code of Federal Regu- 
lations. This adoption bv reference is in accord- 
ance with G.S. 150B- 14(c). 

Statutory Authority G.S. 143B-147; 150B-l(d); 

20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.1517 TIMELINES 

The administrative proceeding shall be com- 
pleted, and a written decision mailed to each of 
the parties within 30 days after the receipt of a 
parent's complaint as described in Rule .1511 of 
this Section. 

Statutory Authority G.S. J43B-147; 150B-l(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.1518 CIVIL ACTION 

Section 303.424 of Subpart E of Part 303 of 
Title 34 of the Code of Federal Regulations re- 
lating to the availability of a civil action for any 
party aggrieved by the findings and decision in 
an administrative proceeding is adopted by refer- 
ence in accordance with G.S. 1 SOB- 14(c). 

Statutory Authority G.S. 143B-147; 150B-l(d); 
20 U.S.C. Sections' 1401 et. seq., 1471 et.seq.. 

.1519 STATUS OF CHILD DURING 
PROCEEDINGS 

Section 303.425 of Subpart E of Part 303 of 
Title 34 of the Code of Federal Regulations re- 
lating to the status of a child durina an adminis- 



trative proceeding is adopted by reference in 
accordance with G.S. 150B- 14(c). 

Statutory Authority G.S. 143B-147; 150B-l(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.1520 MEDIATION 

Parents of an eligible child may request medi- 
ation to resolve a complaint as an intervening 
step prior to the administrative proceeding. If 
mediation is requested, the mediation shall take 
place prior to the administrative proceeding. 
Mediation shall be conducted by the Governor's 
Interagency Advisory Council which was estab- 
lished in response to P.L. 99-457. Mediation 
may not be used to deny or delay a parent's right 
to speedy complaint resolution. The mediative, 
administrative proceeding and written decision 
must be completed within the 30 day timeline set 
forth in Rule .1508 of this Section. 

Statutory Authority G.S. 143B-147; 150B-l(d); 
20 U.S.C. Sections 1401 et. seq., 147 1 et.seq.. 

.1521 CONFIDENTIALITY 

Personally identifiable information concerning 
an eligible child or family member of an eligible 
child is confidential and may not be disclosed or 
acquired except as provided by Rule .1522, .1523, 
and .1525 of this Section. 

Statutory Authority G.S. 143B-147; 150B-I(d); 
20 U.S.C. Sections 1401 et. seq,, 1471 et.seq.. 

.1522 DISCLOSl RE OF CONFIDENTIAL 
INFORMATION TO EMPLOYEES 

An area program or contract agency may dis- 
close confidential information to its employees 
who have a legitimate need for access to the in- 
formation. 

Statutory Authority G.S. 143B-J47; 150B-l(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq.. 

.1523 WRITTEN CONSENT REQL IRED 

Except as provided in Rule .1511 of this Sec- 
tion, all disclosures of confidential information, 
including disclosures between an area program 
and contract agency, may be made only with the 
written consent of the parents. Parents shall be 
informed of their right to refuse to consent to the 
release of confidential information. 

Statutory Authority G.S. 143B-147; 150B-l(d); 
20 U.S.C. Sections 1401 el. seq., 1471 et.seq.. 

.1524 CONTENT OF WRITTEN CONSENT 

(a) When consent for release of information is 
obtained by an area program or contract agency 



6SS 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



covered by the rules in this Subchapter, a consent 
for release form containing the information in 
this Subparagraph shall be utilized. The consent 
form shall contain the following information: 

(1) child's name; 

(2) name of party releasing the information; 

(3) name of individual/agency to whom in- 
formation is being released; 

(4) information to be released; 

(5) purpose for the release; 

(6) length of time consent is valid; 

(7) a statement that the consent is subject to 
revocation at any time; 

(8) signature of parent; 

(9) signature of individual witnessing the 
consent; and 

(10) date the consent is signed, 
(b) The release shall be effective only until the 
initial Individual Family Service Plan is devel- 
oped, or, if an Individual Family Service Plan has 
been developed, until the next Individual Service 
Plan review. 

Statutory Authority G.S. 143B-147; 1 50 B- 1(d); 
20 U.S.C. Sections 1401 el. seq., 1471 et.seq.. 

.1525 RELEASE TO PUBLIC SCHOOLS 

With the consent of the parents, confidential 
information may be provided to the public 
schools if and when the child is enrolled in a 
program under Part B of the Fducation of the 
Handicapped Act. If the parents refuse to con- 
sent, confidential information shall not be re- 
leased to the public schools. 

Statutory Authority G.S. I43B-/47; I SOB- 1(d); 
20 U.S.C. Sections 1401 el. seq., 1471 et.seq.. 

CHAPTER 45 - NORTH CAROLINA DRUG 
COMMISSION 

SUBCHAPTER 4511 - DRLG TREATMENT 
FACILITIES 

SECTION .0200 - SCHEDULES OF 
CONTROLLED SUBSTANCES 

.0202 SCHEDULE I 

(d) Hallucinogenic Substances. Unless specif- 
ically excepted or unless listed in another sched- 
ule, any material, compound, mixture or 
preparation which contains any quantity of the 
following hallucinogenic substances, or which 
contains any of their salts, isomers and salts of 
isomers, whenever the existence of such salts, 
isomers and salts of isomers is possible within the 
specific chemical designation (for purposes of this 
Paragraph only, the term "isomer" includes the 
optical, position and geometric isomers): 



(28) l-[l-(2-thicnyl)cvclohcxyl|pyiTolidine 

Some other names: TCPv - 7473 

Statutory Authority G.S. 90-88; 90-89; 1 43 B- 1 47. 

TITLE 1 1 - DEPARTMENT OF 
INSURANCE 



7V otice is hereby given in accordance with G.S. 
1 SOB- 12 that the N.C. Department of Insurance 
intends to amend rule cited as 1 1 NCAC 10 .0602. 

1 he proposed effective date of this action is Fe- 
bruary I, 1990. 

1 he public hearing will be conducted at 10:00 
a.m. on November 2, 1989 at 4th Floor Confer- 
ence Room (4085), Dobbs Building, 430 N. Sal- 
isbury Street, Raleigh, N.C. 2761 1 . 

(comment Procedures/ Written comments may 
be sent to Ronnie Chamberlain, P.O. Box 26387, 
Raleigh, N.C. 27611. Oral presentations may be 
made at the public hearing. Anyone having ques- 
tions should call Ronnie Chamberlain at (9/9) 
733-3368, or Linda Stott at (919) 733-4700. 

CHAPTER 10 - FIRE AND CASUALTY 
DIVISION 

SECTION .0600 - CONSENT TO RATE 

.0602 CONSENT TO RATE PROCEDURES: 
ESSENTIAL COVERAGES 

(a) An application to effect consent to rate on 
a specific risk of "essential" coverage, as identi- 
fied in Regulation .0402 of this Chapter, in excess 
of the rate promulgated by the North Carolina 
Rate Bureau, shall include, but not be limited to, 
the following: 

(1) a description of the insurance proposed, 
including primary and excess limits, the 
amount of coverage, the property insured, 
the deductible and any other factor used 
for rating, where applicable; 

the rate and premium which would be 
charged without application of consent to 
rate; 
the proposed rate and premium; 

the percent increase. The rate to be 
charged will be presumed reasonable if it 
does not exceed 250 percent of the rate 
which would be charged without applica- 
tion of consent to rate. Any proposed 
rate in excess of 250 percent must be ex- 
plained fully and may be disapproved by 
the commissioner. (This is not required 



(2) 



(3) 

(4) 



NORTH CAROLINA REGISTER 



689 



PROPOSED RULES 



for and docs not apply to "essential" au- 
tomobile physical damage insurance); 

(5) a statement that the rate charged does not 
exceed the rate which would be applicable 
if the applicant had been charged 550 
percent of the rate with no driving record 
points. Any proposed rate in excess of 
550 percent must be explained fully, sub- 
mitted individually, and may be disap- 
proved by the commissioner. (This is 
required for "essential" automobile phys- 
ical damage insurance only); 

(6) the names and addresses of the insurer, 
the writing agent, and the insured; 

(7) the effective date of the proposed rate; 
(S) the policy period; 

(9) the policy number; 

(10) the reason for the surcharge may be re- 
quired; and 

(11) a letter signed by the insured acknowl- 
edging and consenting to the proposed 
rate (not required to be submitted to the 
commissioner for "essential" automobile 
physical damage insurance). If coverage 
for the specific risk written on consent to 
rate is available through a residual market 
(FAIR Plan, Beach Plan, North Carolina 
Reinsurance Facility, North Carolina 
Workers Compensation Insurance Plan), 
a statement signed by the insured ac- 
knowledging that fact must also be sub- 
mitted. 

AU such applications must be forwarded directly 
to the commissioner for approval. 

(b) Such applications involving non-standard 
automobile physical damage insurance may be 
recorded on a form approved by the commis- 
sioner and must be forwarded at frequent inter- 
vals to the commissioner for approval. A letter 
signed by each insured acknowledging and con- 
senting to the proposed rate shall be retained in 
the insurer's office and be made available to the 
commissioner upon request. A separate letter 
with the insureds signature must be obtained for 
each policy period. 

(c) All applications for approval of consent to 
rate received more than 90 days after the effective 
date of the proposed rates will be disapproved 
and construed as effective at the rates which 
would be charged without application of consent 
to rate on the effective date. 

Statutory Authority G.S. 58-124.23(b). 

•k-k-k-k-k-k'k-k-k-k-k-k-k-kic-k-k'k 



No 



otice is hereby given in accordance with G.S. 
I SOB- 1 2 that the N.C. Department of Insurance 
intends to adopt rules cited as 1 1 XCAC 12 .0801 
- .0814. 



Th 



he proposed effective date of this action is Fe- 
hruan I, 1990. 



Th 



he public hearing will be conducted at 10:00 
a.m. on Sovembcr 1 . 1989 at Industrial Commis- 
sion Hearing Room (2063 >, Dobbs Building, 430 
S. Salisbury Street, Raleigh, A'.C. 2761 1. 



Cc 



omment Procedures: Written comments may 
be sent to Leonard Wood. P.O. Box 2638' ', Ra- 
leigh, A'.C. 2~61 1. Oral presentations may be 
made at the public hearing. Anyone having ques- 
tions should call Leonard Wood at (919) 
733-5060. or Linda Slot! at ( 919} n 33-4~?00. 

CHAPTER 12 - LIFE: ACCIDENT AND HEALTH 
DIVISION 

SECTION .0800 - MEDICARE SUPPLEMENT 
INSURANCE 

.0801 PIRPOSE 

The purpose of this Rule is to provide for the 
reasonable standardization of coverage and sim- 
plification of terms and benefits of Medicare 
Supplement Policies; to facilitate public under- 
standing and comparison of such policies; to 
eliminate provisions contained in such policies 
which may be misleadmg or confusing in con- 
nection with the purchase of such policies or with 
the settlement of claims; and to provide for full 
disclosures in the sale of accident and sickness 
insurance coverages to persons eligible for Medi- 
care by reason of age. 

Statutory Authority G.S. 58-9: 58-7/2; 58-713; 

58-715.' 

.0802 APPLICABILITY AND SCOPE 

(a) Except as otherwise specifically provided, 
this rule shall apply to; 

( 1 ) all Medicare Supplement Policies and 
subscriber contracts delivered or issued for 
delivery in this state on or after the effec- 
tive date hereof; and 

(2) all certificates issued under group Medicare 
Supplement Policies or subscriber con- 
tracts, which certificates have been deliv- 
ered or issued for delivery in this state. 

(b) This rule shall not apply to: 

(1) a policy or contract of one or more em- 
ployers or labor organizations; 



690 



SORTH CAROLINA REGISTER 



PROPOSED RULES 



(2) the trustees of a fund established by one 
or more employers or labor organizations, 
or combination thereof; 

(3) for employees or former employees, or a 
combination thereof; or 

(4) for members, or a combination thereof, 
of the labor organizations. 

Statutory Authority G.S. 58-9; 59-711. 

.0803 DEFINITIONS 

For the purpose of this rule: 

(1) "Applicant" means: 

(a) in the case of an individual Medicare 
Supplement Policy or subscriber contract, 
the person who seeks to contract for in- 
surance benefits, and 

(b) in the case of a group Medicare Supple- 
ment Policy or subscriber contract, the 
proposed ccrtificateholder. 

(2) "Certificate" means, for the purpose of this 
Rule, any certificate issued under a group 
Medicare Supplement Policy, which certif- 
icate has been delivered or issued for delivery 
in this state. 

(3) "Medicare Supplement Policy" means a 
group or individual policy of accident and 
health insurance or a subscriber contract of 
hospital and medical service corporations or 
health maintenance organizations which is 
advertised, marketed or designed primarily 
as a supplement to reimbursements under 
Medicare for the hospital, medical or surgi- 
cal expenses of persons eligible for Medicare 
by reason of age. 

Statutory Authority G.S. 58-9; 58-7/0. 

.0804 POLICY DEFINITIONS AND TERMS 

No insurance policy or subscriber contract may 
be advertised, solicited or issued for delivery in 
this state as a Medicare Supplement Policy unless 
such policy or subscriber contract contains defi- 
nitions or terms which conform to the require- 
ments of this Section. 
(1) "Accident", "Accidental Injury", or "Ac- 
cidental Means" shall be defined to employ 
"result" language and shall not include 
words which establish an accidental means 
test or use words such as "external, violent, 
visible wounds" or similar words of de- 
scription or characterization, 
(a) The definition shall not be more restrictive 
than the following: "Injury or injuries for 
which benefits are provided means acci- 
dental bodily injury sustained by the in- 
sured person which is the direct result of 
an accident, independent of disease or 



bodily infirmity or any other cause, and 
occurs while insurance coverage is in 
force", 
(b) Such definition may provide that injuries 
shall not include injuries for which bene- 
fits are provided or available under any 
workers' compensation, employer's liabil- 
ity or similar law, or motor vehicle no- 
fault plan, unless prohibited by law. 

(2) "Benefit Period" or "Medicare Benefit 
Period" shall not be defined as more restric- 
tive than as that defined in the Medicare 
program. 

(3) "Convalescent Nursing Home", "Extended 
Care Facility", or "Skilled Nursing Facility" 
shall be defined in relation to its status, fa- 
culties and available services. 

(a) A definition of such home or facility shall 
not be more restricti%'e than one requiring 
that it: 

(i) be operated pursuant to law; 

(ii) be approved for payment of Medicare 
benefits or be qualified to receive such 
approval, if so requested; 

(iii) be primarily engaged in providing, in 
addition to room and board accommo- 
dations, skilled nursing care under the su- 
pervision of a duly licensed physician; 

(iv) provide continuous 24 hours a day 
nursing service by or under the super- 
vision of a registered graduate profession 
nurse (R.N.); and 

(v) maintains a daily medical record of each 
patient. 

(b) The definition of such home or facility 
may provide that such term not be inclu- 
sive of: 

(i) any home, facility or part thereof used 

primarily for rest; 
(ii) a home or facility for the aged or for the 

care of drug addicts or alcoholics; or 
(iii) a home or facility primarily used for the 

care and treatment of mental diseases or 

disorders, or custodial or educational care. 

(4) "Health Care Expenses" means expenses 
of health maintenance organizations associ- 
ated with the delivery of health care services 
which are analogous to incurred losses of 
insurers. Such expenses shall not include: 

(a) home office and overhead costs; 

(b) advertising costs; 

(c) commissioners and other acquisition costs; 

(d) taxes; 

(e) capital costs; 

(f) administrative costs; or 

(g) claims processing costs. 

(5) "Hospital" may be defined in relation to 
its status, facilities and available services or 



NORTH CAROLINA REGISTER 



691 



PROPOSED RULES 



to reflect its accreditation by the Joint 
Commission on Accreditation of Hospitals. 

(a) The definition of the term "hospital" shall 
not be more restrictive than one requiring 
that the hospital: 

(i) be an institution operated pursuant to 
law; and 

(ii) be primarily and continuously engaged 
in providing or operating, cither on its 
premises or in facilities available to the 
hospital on a prearranged basis and under 
the supervision of a staff of duly licensed 
physicians, medical, diagnostic and major 
surgical facilities for the medical care and 
treatment of sick or injured persons on an 
inpatient basis for which charge is made; 
and 

(iii) provide 24 hour nursing service by or 
under the supervision of registered gradu- 
ate professional nurses (R.N.s). 

(b) The definition of the term "hospital" may 
state that such term shall not be inclusive 
of: 

(i) convalescent homes, convalescent, rest 
or nursing facilities; or 

(ii) facilities primarily affording custodial, 
educational or rehabilitation care; or 

(iii) facilities for the aged, drug addicts or 
alcoholics; or 

(iv) any military or veterans hospital or 
soldiers home or any hospital contracted 
for or operated by any national govern- 
ment or agency thereof for the treatment 
of members or ex-members of the armed 
forces, except for services rendered on an 
emergency basis where a legal liability ex- 
ists for charges made to the individual for 
such services. 

(6) "Medicare" shall be defined in the policy. 
Medicare may be substantially defined as 
"The Health Insurance for the Aged Act, 
Title XVIII of the Social Security Amend- 
ments of 1%5 as Then Constituted or loiter 
Amended", or "Title I, Part I of Public Law 
89-97, as Enacted by the Eighty-Ninth 
Congress of the United States of America 
and popularly known as the Health Insur- 
ance for the Aged Act, as then constituted 
and any later amendments or substitutes 
thereof", or words of similar import. 

(7) "Medicare Eligible Expenses" shall mean 
health care expenses of the kinds covered by 
Medicare, to the extent recognized as rea- 
sonable by Medicare. Payment of benefits 
by insurers for Medicare eligible expenses 
may be conditioned upon the same or less 
restrictive payment conditions, including 



determinations of medical necessity as are 
applicable to Medicare claims. 

(8) "Mental or Nervous Disorders" shall not 
be defined more restrictively than a defi- 
nition including neurosis, psychoncurosis, 
psychopathy, psychosis, or mental or emo- 
tional disease or disorder of any kind. 

(9) "Nurses" may be defined so that the de- 
scription of nurse is restricted to a type of 
nurse, such as Registered Graduate Profes- 
sional Nurse (R.N.), a Licensed Practical 
Nurse (L.P.N. ), or a Licensed Vocational 
Nurse (L.V.N. ). If the words "nurse", 
"trained nurse", or "registered nurse" are 
used without specific instruction, then the 
use of such terms requires the insurer to re- 
cognize the services of any individual who 
qualified under such terminology in accord- 
ance with the applicable statutes or admin- 
istrative rules of the licensing or registry 
board of the state. 

(10) "Physician" may be defined by including 
words such as "duly qualified physician" or 
"duly licensed physician". The use of such 
terms requires an insurer to recognize and to 
accept, to the extent of its obligation under 
the contract, all providers of medical care 
and treatment when such services are within 
the scope of the provider's Licensed authority 
and are provided pursuant to applicable 
laws. 

(11) "Sickness" shall not be defined to be more 
restrictive than the following: "Sickness 
means sickness or disease of an insured per- 
son which first manifests itself after the ef- 
fective date of insurance and while the 
insurance is in force". The definition may 
be further modified to exclude sicknesses or 
diseases for which benefits are provided un- 
der any workers' compensation, occupa- 
tional disease, employer's liability or similar 
law. 

Statutory Authority G.S. 58-9; 5S-7 1 1 ; 58-712; 
58-7/3.' 

.0805 PROHIBITED POLICY PROVISIONS 

(a) No insurance policy or subscriber contract 
may be advertised, solicited or issued for delivery 
in this state as a Medicare Supplement Policy if 
such policy or subscriber contract limits or ex- 
cludes coverage by type of illness, accident, 
treatment or medical condition, except as fol- 
lows: 

(1) foot care in connection with corns, cal- 
luses, flat feet, fallen arches, weak feet, 
chronic foot strain, or symptomatic com- 
plaints of the feet; 



(I 



692 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(2) mental or emotional disorders, alcoholism 
and drug addiction; 

(3) illness, treatment or medical condition 
arising out of: 

(A) war or act of war (whether declared or 
undeclared); participation in a felony, riot 
or insurrection; service in the armed forces 
or units auxiliary thereto; 

(B) suicide (sane or insane), attempted sui- 
cide or intentionally self-inflicted injury; 

(C) aviation. 

(4) cosmetic surgery, except that "cosmetic 
surgery" shall not include reconstructive 
surgery when such service is incidental to 
or follows surgery resulting from trauma, 
infection or other diseases of the involved 
part; 

(5) care in connection with the detection and 
correction by manual or mechanical me- 
ans of structural imbalance, distortion, or 
subluxation in the human body for pur- 
poses of removing nerve interference and 
the effect thereof, where such interference 
is the result of or related to distortion, 
misalignment or subluxation of or in the 
vertebral column; 

(6) treatment provided in a governmental 
hospital; benefits provided under Medi- 
care or other governmental program (ex- 
cept Medicaid), any state or federal 
workers' compensation, employer's liabil- 
ity or occupational disease law, or any 
motor vehicle no-fault law; services ren- 
dered by employees of hospitals, labora- 
tories or other institutions; services 
performed by a member of the covered 
person's immediate family and services for 
which no charge is normally made in the 
absence of insurance; 

(7) dental care or treatment; 

(8) eye glasses, hearing aids and examination 
for the prescription or fitting thereof; 

(9) rest cures, custodial care, transportation 
and routine physical examinations; 

(10) territorial limitations outside the United 
States; 
provided, however, supplemental policies may 
not contain, when issued, limitations or exclu- 
sions of the type enumerated in Paragraphs (a) 
(1), (5), (9), or (10) of this Rule that are more 
restrictive than those of Medicare. Medicare 
Supplement Policies may exclude coverage for 
any expense to the extent of any benefit available 
to the insured under Medicare. 

(b) No Medicare Supplement Policy may use 
waivers to exclude, limit or reduce coverage or 
benefits for specifically named or described pre- 
existing diseases or physical conditions. 



(c) The terms "Medicare Supplement", "Me- 
digap" and words of similar import shall not be 
used unless the policy is issued in compliance 
with this regulation. 

(d) No Medicare Supplement Insurance Policy, 
contract or certificate in force in the state shall 
contain benefits which duplicate benefits pro- 
vided by Medicare. 

Statutory Authority G.S. 5S-9; 58-712. 

.0806 MINIMUM BENEFIT STANDARDS 

No insurance policy or subscriber contract may 
be advertised, solicited or issued for delivery in 
this state as a Medicare Supplement Policy which 
does not meet the following minimum standards. 
These are minimum standards and do not pre- 
clude the inclusion of other provisions or benefits 
which are not inconsistent with these standards. 
(1) General Standards. The following stand- 
ards apply to Medicare Supplement Policies 
and are in addition to all other requirements 
of this regulation: 

(a) A Medicare Supplement Policy may not 
deny a claim for losses incurred more than 
six months from the effective date of cov- 
erage for a preexisting condition. The 
policy may not define a preexisting con- 
dition more restrictively than a condition 
for which medical advice was given or 
treatment was recommended by or re- 
ceived from a physician within six months 
before the effective date of coverage. 

(b) A Medicare Supplement Policy may not 
indemnify against losses resulting from 
sickness on a different basis than losses 
resulting from accidents. 

(c) A Medicare Supplement Policy shall pro- 
vide that benefits designed to cover cost 
sharing amounts under Medicare will be 
changed automatically to coincide with 
any changes in the applicable Medicare 
deductible amount and copayment per- 
centage factors. Premiums may be modi- 
fied to correspond with such changes. 

(d) A "noncanccllable", "guaranteed renewa- 
ble", or "noncanccllable and guaranteed 
renewable" Medicare Supplement Policy 
shall not: 

(i) provide for termination of coverage of a 
spouse solely because of the occurrence 
of an event specified for termination of 
coverage of the insured, other than the 
nonpayment of premium; or 

(ii) be cancelled or nonrenewed by the in- 
surer solely on the grounds of deteri- 
oration of health; and 



NORTH CAROLINA REGISTER 



693 



PROPOSED RULES 



(2) 
(a) 



(b) 



(c) 



(c) Termination of a Medicare Supplement 
Policy shall be without prejudice to any 
continuous loss which commenced while 
the policy was in force, but the extension 
of benefits beyond the period during 
which the policy was in force may be 
predicated upon the continuous total dis- 
ability of the insured, limited to the dura- 
tion of the policy benefit period, if any, 
or payment of the maximum benefits. 

Minimum Benefit Standards. 

Coverage for either all or none of the 
Medicare Part A inpatient hospital de- 
ductible amount. 

Coverage for the daily copayment amount 
of Medicare Part A eligible expenses for 
the first eight days per calendar year in- 
curred for skilled nursing facility care. 
Coverage for the reasonable cost of the 
first three pints of blood (or equivalent 
quantities of packed red blood cells, as 
defined under federal regulations) under 
Medicare Part A unless replaced in ac- 
cordance with federal regulations. 

(d) Until January 1. 1 9907 coverage for 20 
percent of the amount of Medicare eligible 
expenses under Part B regardless of hos- 
pital confinement, subject to a maximum 
calendar year out-of-pocket deductible of 
two hundred dollars ($200.00) of such ex- 
penses and to a maximum benefit of at 
least five thousand dollars ($5,000.00) per 
calendar year. 

Effective January 1, 1990, coverage for the 
copayment amount (20 percent) of Medi- 
care eligible expenses excluding outpatient 
prescription drugs under Medicare Part B 
regardless of hospital confinement up to 
the maximum out-of-pocket amount for 
Medicare Part B after the Medicare de- 
ductible amount. 

(e) Effective January 1, 1990, coverage under 
Medicare Part B for the reasonable cost 
of the first three pints of blood (or equiv- 
alent quantities of packed red blood cells, 
as defined under federal regulations), un- 
less replaced in accordance with federal 
regulations. 

(f) Effective January 1 , 1 990, coverage for the 
copayment amount (20 percent) of Medi- 
care eligible expenses for covered home 
intravenous (IV) therapy drugs (as deter- 
mined by the Secretary of Health and 
Human Services) subject to the Medicare 
outpatient prescription drug deductible 
amount, if applicable. 

(g) Effective January 1, 1990, coverage for the 
copayment amount (20 percent) of Medi- 



care eligible expenses for outpatient drugs 
used in immunosuppressive therapy, sub- 
ject to the Medicare outpatient pre- 
scription drug deductible, if applicable. 
(3) Medicare Eligible Expenses. Medicare eli- 
gible expenses shall mean health care ex- 
penses of the kinds covered by Medicare, to 
the extent recognized as reasonable by 
Medicare. Payment of benefits by insurers 
for Medicare eligible expenses may be con- 
ditioned upon the same or less restrictive 
payment conditions, including determi- 
nations of medical necessity as are applicable 
to Medicare claims. 

Statutory Authority G.S. 58-9; 58-712; 58-713. 

.0807 STANDARDS FOR CLAIMS PAYMENT 

(a) Every entity providing Medicare Supple- 
ment Policies or contracts shall comply with all 
provisions of Section 40S1 of the Omnibus 
Budget Reconciliation Act of 1987 (P.L. 100- 
203). 

(b) Compliance with the requirements set forth 
in Paragraph (a) of this Rule must be certified 
on the Medicare Supplement insurance experi- 
ence reporting form. 

Statutory Authority G.S. 58-9; 58-7/3. 

.0808 [.OSS RATIO STANDARDS 

Medicare Supplement Policies shall return to 
policyholders in the form of aggregate benefits 
under the policy, for the entire period for which 
rates arc computed to provide coverage, on the 
basis of incurred claims experience or incurred 
health care expenses where coverage is provided 
by a health maintenance organization on a ser- 
vice rather than reimbursement basis and earned 
premiums for such period and in accordance with 
accepted actuarial principles and practices: 

( 1 ) At least 75 percent of the aggregate amount 
of premiums earned in the case of group 
policies; and 

(2) At least 65 percent of the aggregate amount 
of premiums earned in the case of individual 
policies. All filings of rates and rating sche- 
dules shall demonstrate that actual and ex- 
pected losses in relation to premiums 
comply with the requirements of this Sec- 
tion. 

(3) Every entity providing Medicare Supple- 
ment Policies in this state shall file annually 
its rates, rating schedule and supporting do- 
cumentation including ratios of incurred 
losses to earned premiums by number of 
years of policy duration demonstrating that 
it is in compliance with the foregoing appli- 



694 



SORTH CAROLINA REGISTER 



PROPOSED RULES 



cable loss ratio standards and that the period 
for which the policy is rated is reasonable in 
accordance with accepted actuarial principles 
and experience. For the purposes of this 
Section, policy forms shall be deemed to 
comply with the loss ratio standards if: 

(a) for the most recent year, the ratio of the 
incurred losses to earned premiums for 
policies or certificates which have been in 
force for three years or more is greater 
than or equal to the applicable percent- 
ages contained in this Section; and 

(b) the expected losses in relation to premi- 
ums over the entire period for which the 
policy is rated comply with the require- 
ments of this Section. An expected 
third-year loss ratio which is greater than 
or equal to the applicable percentage shall 
be demonstrated for policies or certificates 
in force less than three years. 

(4) As soon as practicable, but no later than 
60 days prior to the effective date of Medi- 
care benefit changes required by the Medi- 
care Catastrophic Coverage Act of 1988, 
every insurer, health care service plan or 
other entity providing Medicare Supplement 
insurance of contracts in this state (except 
employers subject to the requirements of 
Section 421 of the Medicare Catastrophic 
Act of 1988), shall file with the Commis- 
sioner, in accordance with the applicable fil- 
ing procedures of this state; 
(a) Appropriate premium adjustments neces- 
sary to produce loss ratios as originally 
anticipated for the applicable policies or 
contracts. Such supporting documents as 
necessary to justify the adjustment shall 
accompany the filing. Every insurer, 
health care service plan or other entity 
providing Medicare Supplement insurance 
or benefits to a resident of this state pur- 
suant to N.C.G.S. 58-71 1 shall make such 
premium adjustments as are necessary to 
produce an expected loss ratio under such 
policy or contract as will conform with 
minimum loss ratio standards for Medi- 
care Supplement Policies and which are 
expected to result in a loss ratio at least 
as great as that originally anticipated in 
the rates used to produce current premi- 
ums by the insurer, health care service 
plan or other entity for such Medicare 
Supplement Insurance Policies or con- 
tracts. No premium adjustment which 
would modify the loss ratio experience 
under the policy other than the adjust- 
ments described herein should be made 
with respect to a policy at any time other 



than upon its renewal date or anniversary 
date. Premium adjustments shall be in 
the form of refunds or premium credits 
and shall be made no later than upon re- 
newal if a credit is given, or within 60 days 
of the renewal date or anniversary date if 
a refund is provided to the premium 
payer. Premium adjustments shall be 
calculated for the period commencing 
with Medicare benefit changes, 
(b) Any appropriate riders, endorsements or 
policy forms needed to accomplish the 
Medicare Supplement insurance modifi- 
cations necessary to eliminate benefit du- 
plications with Medicare. Any such 
endorsements or policy forms shall pro- 
vide a clear description of the Medicare 
Supplement benefits provided by the pol- 
icy or contract. 

Statutory Authority G.S. 58-9; 58-714. 

.0809 FILING REQUIREMENTS FOR 

OUT-OF-STATE GROUP POLICIES 

Every insurer providing group Medicare Sup- 
plement insurance benefits to a resident of this 
state pursuant to N.C.G.S. 58-711 shall file a 
copy of the master policy and any certificate used 
in this state in accordance with the filing re- 
quirements and procedures applicable to group 
Medicare Supplement Policies issued in this 
state; provided, however, that no insurer shall be 
required to make a filing earlier than 3 1 days after 
insurance was provided to a resident of this state 
under a master policy issued for delivery outside 
this state. 

Statutory Authority G.S. 58-9; 58-714. 

.0810 PROHIBITED COMPENSATION FOR 
REPLACEMENT WITH THE SAME CO 

No entity shall provide compensation to its 
agents or other producers which is greater than 
the renewal compensation which would have 
been paid on an existing policy is replaced by 
another policy with the same company where the 
new policy benefits arc substantially similar to 
the benefits under the old policy and the old 
policy was issued by the same insurer or insurer 
group. 

Statutory Authority G.S. 58-9; 58-714. 

.0811 REQUIRED DISCLOSURE 
PROVISIONS 

(a) General Rules. 
(1) Medicare Supplement Policies shall in- 
clude a renewal, continuation or nonre- 
newal provision. The language or 



NORTH CAROLINA REGISTER 



695 



PROPOSED RULES 



specifications of such provisions must be 
consistent with the type of contract to be 
issued. Such provision shall be appropri- 
ately captioned, shall appear on the first 
page of the policy, and shall clearly state 
the duration, where limited, or renewabil- 
ity and the duration of the term of cover- 
age for which the policy is issued and for 
which it may be renewed. 

(2) Fxcept for riders or endorsements by 
which the insurer effectuates a request 
made in writing by the insured, exercises 
a specifically reserved right under a Medi- 
care Supplement Policy, or is required to 
reduce or eliminate benefits to avoid du- 
plication of Medicare benefits; all riders 
or endorsements added to a Medicare 
Supplement Policy after date of issue or 
at reinstatement or renewal which reduce 
or eliminate benefits or coverage in the 
policy shall require a signed acceptance 
by the insured. After the date of policy 
issue, any rider or endorsement which in- 
creases benefits or coverage with a con- 
comitant increase in premium during the 
policy term must be agreed to in writing 
signed by the insured, unless the benefits 
are required by the minimum standards 
for Medicare Supplement Insurance Poli- 
cies, or if the increased benefits or cover- 
age is required by law. Where a separate 
additional premium is charged for benefits 
provided in connection with riders or en- 
dorsements, such premium charge shall 
be set forth in the policy. 

(3) A Medicare Supplement Policy which 
provides for the payment of benefits based 
on standards described as "usual and cus- 
tomary", "reasonable and customary" or 
words of similar import shall include a 
definition of such terms and an explana- 
tion of such terms in its accompanying 
outline of coverage. 

(4) If a Medicare Supplement Policy contains 
any limitations with respect to preexisting 
conditions, such limitations must appear 
as a separate paragraph of the policy and 
be labeled as "Preexisting Condition Li- 
mitations". 

(5) Medicare Supplement Policies or certif- 
icates shall have a notice prominently 
printed on the first page of the policy or 
certificate or attached thereto stating in 
substance that the policyholder or certifi- 
cateholder shall have the right to return 
the policy or certificate within 30 days of 
its delivery and to have the premium re- 
funded if, after examination of the policy 



or certificate, the insured person is not 
satisfied for any reason. 
(6) Insurers issuing accident and health poli- 
cies, certificates or subscriber contracts 
which provide hospital or medical expense 
coverage on an expense incurred or in- 
demnity basis, other than incidentally, to 
persons eligible for Medicare by reason of 
age shall provide to all applicants a Med- 
icare Supplement Buyer's Guide in the 
form developed jointly by the National 
Association of Insurance Commissioners 
and the Health Care Financing Adminis- 
tration. Delivery of the Buyer's Guide 
shall be made whether or not such poli- 
cies, certificates or subscriber contracts are 
advertised, solicited or issued as Medicare 
Supplement Policies as defined in this 
Rule. Except in the case of direct re- 
sponse insurers, delivery of the Buyer's 
Guide shall be made to the applicant at 
the time of application and acknowledge- 
ment of receipt of the Buyer's Guide shall 
be obtained by the insurer. Direct re- 
sponse insurers shall deliver the Buyer's 
Guide to the applicant upon request but 
not later than at the time the policy is de- 
livered. 
(b) Notice Requirements. 

(1) As soon as practicable, but no later than 
30 days prior to the annual effective date 
of any Medicare benefit changes, every 
insurer, health care service plan or other 
entity providing Medicare Supplement 
Insurance or benefits to a resident of this 
state shall notify its policyholders, con- 
tract holders and certificate holders of 
modifications it has made to Medicare 
Supplement Insurance Policies or con- 
tracts in a format acceptable to the Com- 
missioner. For the years 1989 and 1990 
and if prescription drugs are covered in 
1991, such notice shall be in a format 
prescribed by the Commissioner or in the 
format prescribed in Forms C, D and E 
if no other format is prescribed by the 
Commissioner. In addition, such notice 
shall: 

(A) Include a description of revisions to the 
Medicare program and a description of 
each modification made to the coverage 
provided under the Medicare Supplement 
Insurance Policy or contract; and 

(B) Inform each covered person as to when 
any premium adjustment is to be made 
due to changes in Medicare. 

(2) The notice of benefit modifications and 
any premium adjustments shall be in 



696 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



outline form and in clear and simple terms 
so as to facilitate comprehension. 
(3) Such notices shall not contain or be ac- 
companied by any solicitation, 
(c) Outline of coverage requirements for Med- 
icare Supplement Policies. 

(1) Insurers issuing Medicare Supplement 
Policies or certificates for delivery in this 
state shall provide an outline of coverage 
to all applicants at the time application is 
made and, except for direct response poli- 
cies, shall obtain an acknowledgement of 
receipt of such outline from the applicant; 
and 

(2) If an outline of coverage is provided at the 
time of application and the Medicare 
Supplement Policy or certificate is issued 
on a basis which would require revision 
of the outline, a substitute outline of cov- 
erage properly describing the policy or 
certificate when it is delivered and contain 
the following statement, in no less than 
12 point type, immediately above the 
company name: 

"NOTICE: Read this outline of coverage 
carefully. It is not identical to the outline 
of coverage provided upon application 
and the coverage originally applied for has 
not been issued." 

(3) The outline of coverage provided to ap- 
plicants pursuant to Paragraph (2) shall 
be in the form prescribed below: 

[COMPANY NAME] 

OUTLINE OF MEDICARE 

SUPPLEMENT COVERAGE 

(A) Read your policy carefully - This out- 
line of coverage provides a very brief de- 
scription of the important features of your 
policy. This is not the insurance contract 
and only the actual policy provisions will 
control. The policy itself sets forth in 
detail the rights and obligations of both 
you and your insurance company. It is, 
therefore, important that you READ 
YOUR POLICY CAREFULLY! 

(B) Medicare Supplement Coverage - Poli- 
cies of this category are designed to sup- 
plement Medicare by covering some 
hospital, medical and surgical services 
which are partially covered by Medicare. 
Coverage is provided for hospital inpa- 
tient charges and some physician charges, 
subject to any deductibles and copayment 
provisions which may be in addition to 
those provided by Medicare, and subject 



to other limitations which may be set 
forth in the policy. The policy docs not 
provide benefits for custodial care such as 
help in walking, getting in and out of bed, 
eating, dressing, bathing and taking medi- 
cine [delete if such coverage is provided]. 

(C) A. [for agents:) 

Neither [insert company's name] nor its 
agents are connected with Medicare. 

B. [for direct responses:] 
[insert company's name) is not connected 
with Medicare. 

(D) [A brief summary of the major medical 
benefit gaps in Medicare Parts A & B with 
a parallel description of supplemental be- 
nefits, including dollar amounts (and in- 
dexed copayments or deductibles, as 
appropriate), provided by the Medicare 
Supplement coverage in the following 
order:] 

DESCRIPTION 
SERVICE 
PART A 
INPATIENT HOSPITAL SERVICES: 

Semi- Private Room & Board 

Miscellaneous Hospital Services 

& Supplies, such as Drugs, 

X-Rays, Lab Tests & Operating Room 
SKILLED NURSING FACILITY CARE 

Blood 
PARIS A & B 

Home Health Services 
PART B 
MEDICAL EXPENSE: 

Services of a Physician/ 

Outpatient Services 

Medical Supplies and other than 

Prescribed Drugs 
BLOOD 

MAMMOGRAPHY SCREENING 
OUT-OF-POCKET MAXIMUM 
PRESCRIPTION DRUGS 
MISCELLANEOUS 

Home IV- Drug Therapy 

Immunosuppresive Drugs 

Respite Care Benefits 



THIS POLICY PAYS 



YOU PAY 



IN ADDITION TO THIS OUTLINE OF COV 
ERAGE, [INSURANCE COMPANY NAME) 
WILL SEND AN ANNUAL NOTICE TO YOU 30 
DAYS PRIOR TO THE EFFECTIVE DATE OF 
MEDICARE CHANGES WHICH WILL DE 
SCRIBE THESE CHANGES AND THE 
CHANGES IN YOUR MEDICARE SUPPLE- 
MENT COVERAGE. 

(E) Form A and Form B shall accompany 

the outline of coverage as described in 

Paragraph (c)(4) of this Rule. 



NORTH CAROLINA REGISTER 



697 



PROPOSED RULES 



(F) Statement that the policy does or does 
not cover the following: 

(i) Private duty nursing; 

(ii) Skilled nursing home care costs (be- 
yond what is covered by Medicare); 

(iii) Custodial nursing home care costs; 

(iv) Intermediate nursing home care 
costs; 

(v) Home health care above number of 
visits covered by Medicare; 

(vi) Physician charges (above Medicare's 
reasonable charges); 

(vii) Drugs (other than prescription drugs 
furnished during a hospital or skilled 
nursing facility stay); 

(viii) Care received outside the U.S.A.; 

(ix) Dental care or dentures, checkups, 
routine immunizations, cosmetic sur- 
gery, routine foot care, examinations for 
the cost of eyeglasses or hearing aids. 

(G) A description of any policy provisions 
wruch exclude, eliminate, resist, reduce, 
limit, delay, or in any other manner oper- 
ate to qualify payments of the benefits 
described in Paragraph (a)(4) of this Rule, 
including conspicuous statements; 

(i) That the chart summarizing Medicare 
benefits only briefly describes such be- 
nefits, 
(ii) That the Health Care Financing Ad- 
ministration or its Medicare publica- 
tions should be consulted for further 
details and limitations. 
(H) A description of policy provisions re- 
specting renewability or continuation of 
coverage, including any reservation of 
rights to change premium. 
(I) The amount of premium for this policy, 
(d) Notice regarding policies or subscriber 
contracts which are not medicare supplement 
policies. Any accident and health insurance 
policy or subscriber contract, other than a Medi- 
care Supplement Policy; disability income policy; 
basic, catastrophic, or major medical expense 
policv; single premium nonrenewable policy or 
other policy identified 11 NCAC 12 .0803(b), is- 
sued for delivery in this state to persons eligible 
for Medicare by reason of age shall notify in- 
sureds under the policy or subscriber contract 
that the policy or subscriber contract is not a 
Medicare Supplement Policy. Such notice shall 
either be printed or attached to the first page of 
the outline of coverage delivered to insureds un- 
der the policy or subscriber contract, or if no 
outline of coverage is delivered, to the first page 
of the policy, certificate or subscriber contract 
delivered to insureds. Such notice shall be in no 



less than 12 point type and shall contain the fol- 
lowing language: 

"THIS [POLICY, CERTIFICATE OR SUB 
SCRIBER CONTRACT] IS NOT A MEDICARE 
SUPPLEMENT [POLICY OR CONTRACT]. If 
you are eligible for Medicare, review the Medi- 
care Supplement Buyer's Guide available from 
the company." 

Statutory Authority G.S. 5S-9; 58-715. 

.0812 REQUIREMENTS FOR REPLACEMENT 

(a) Application forms shall include a question 
designed to elicit information as to whether a 
Medicare Supplement Policy or certificate is in- 
tended to replace any other accident and health 
policy or certificate presently in force. A sup- 
plementary application or other form to be 
signed by the applicant containing such a ques- 
tion may be used. 

(b) I pon determining that a sale will involve 
replacement, an insurer, other than a direct re- 
sponse insurer, or its agent, shall furnish the ap- 
plicant, prior to issuance or delivery of the 
Medicare Supplement Policy or certificate, a no- 
tice regarding replacement of accident and health 
coverage. One copy of such notice shall be pro- 
vided to the applicant and an additional copy 
signed by the applicant shall be retained by the 
insurer. A direct response insurer shall deliver to 
the applicant at the time of the issuance of the 
policy the notice regarding replacement of acci- 
dent and sickness coverage. In no event, how- 
ever, will such a notice be required in the 
solicitation of "accident only" and "single pre- 
mium nonrenewable" policies. 

(c) The notice required by Paragraph (b) of this 
Rule for an insurer, other than a direct response 
insurer, shall be provided in substantially the 
following form: 

NOTICE TO APPLICANT REGARDING 

REPLACEMENT OE ACCIDENT 

AND SICKNESS INSURANCE 

According to [your application] [information you 
have furnished], you intend to lapse or otherwise 
terminate existing accident and health insurance 
and replace it with a policy to be issued by 
[company name] Insurance Company. Your 
new policy provides 30 days within which you 
may decide without cost whether you desire to 
keep the policy. For your own information and 
protection, you should be aware of and seriously 
consider certain factors which may affect the in- 
surance protection available to you and under the 
new policy. 

(1) Health conditions which you may pres- 
ently have (preexisting conditions) may 



69 S 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(2) 



(3) 



not be immediately or fully covered under 
the new policy. This could result in de- 
nial or delay of a claim for benefits under 
the new policy, whereas a similar claim 
might have been payable under your pre- 
sent policy. 

You may wish to secure the advice of your 
present insurer or its agent regarding the 
proposed replacement of your present 
policy. This is not only your right, but it 
is also in your best interest to make sure 
you understand all the relevant factors in- 
volved in replacing your present coverage. 
If, after due consideration, you still wish 
to terminate your present policy and re- 
place it with new coverage, be certain to 
truthfully and completely answer all 
questions on the application concerning 
your medical health history. Failure to 
include all material medical information 
on an application may provide a basis for 
the company to deny any future claims 
and to refund your premium as though 
your policy had never been in force. After 
the application has been completed and 
before you sign it, reread it carefully to be 
certain that all information has been 
properly recorded. 



The above "Notice to Applicant" was delivered 
to me on: 



the insurance protection available to you under 
the new policy. 

(1) Health conditions which you may pres- 
ently have (preexisting conditions) may 
not be immediately or fully covered under 
the new policy. This could result in de- 
nial or delay of a claim for benefits under 
the new policy, whereas a similar claim 
might have been payable under your pre- 
sent policy. 

(2) You may wish to secure the advice of your 
present insurer or its agent regarding the 
proposed replacement of your present 
policy. This is not only your right, but it 
is also in your best interest to make sure 
you understand all the relevant factors in- 
volved in replacing your present coverage. 

(3) [to be included only if the application is 
attached to the policy] If, after due con- 
sideration, you still wish to terminate your 
present policy and replace it with new 
coverage, read the copy of the application 
attached to your new policy and be sure 
that all questions are answered fully and 
correctly. Omissions or misstatements in 
the application could cause an otherwise 
valid claim to be denied. Carefully check 
the application and write to [Company 
Name and Address] within ten days if any 
information is not correct and complete, 
or if any past medical history has been left 
out of the application. 



(DATE) 



(Company Name) 



(Applicant's Signature) 

(d) The notice required by Paragraph (b) of 
this Rule for a direct response shall be as follows: 

NOTICE TO APPLICANT REGARDING 

REPLACEMENT OF ACCIDENT 

AND SICKNESS INSURANCE 

According to [your application) [information you 
have furnished] you intend to lapse or otherwise 
terminate existing accident and sickness insurance 
and replace it with the policy delivered herewith 
issued by [company name] Insurance Company. 
Your new policy provides 30 days within which 
you may decide without cost whether you desire 
to keep the policy. For your own information 
and protection, you should be aware of and seri- 
ously consider certain factors which may affect 



Statutory Authority G.S. 58-9; 58-7/5. 

.0813 FILING REQUIREMENTS FOR 
ADVERTISING 

Every insurer, hospital or medical service cor- 
poration or health maintenance organization or 
other entity providing Medicare Supplement in- 
surance or benefits in this state shall provide a 
copy of any Medicare Supplement advertisement 
intended for use in this state whether through 
written, radio or television medium to the Com- 
missioner of Insurance of this State for review or 
approval by the Commissioner to the extent it 
may be required under state law. 

Statutory Authority G.S. 58-9; 58-7/7. 

.0814 FORMS 

The forms referenced in Medicare Supplement 
Policies Regulations arc as follows: 



NORTH CAROLINA REGISTER 



699 



PROPOSED RULES 



(1) Form A lists services covered under Medi- 
care Part A and describes benefits covered 
for 1988, 1989, 1990 and 1991. 

(2) Form B lists services covered under Medi- 
care Part B and describes benefits covered 
for 198S. 1989, 1990 and 1991. 

(3) Form C is a notice that describes any 
chanties in Medicare coverages for 1989 and 
any resulting changes in Medicare Supple- 
ment coverage. "Phis notice must include 
the name of the company issuing the policy 
as well as the agent who sells the Medicare 
Supplement policy. 

(4) form D is a notice that describes any 
changes in Medicare coverage for 1990 and 
any resulting changes in Medicare Supple- 
ment Coverage. "Phis notice must include 
the name of the company issuing the policy 
as well as the name of the agent who sells 
the Medicare Supplement Policy. 

(5) Form F is a notice that describes any 
changes in Medicare coverage for 1991 and 
any resulting changes in Medicare Supple- 
ment Coverage. This notice must include 
the name of the company issuing the policy 
as well as the name of the agent who sells 
the Medicare Supplement Policy. 

(6) All forms described in this Rule may be 
obtained in the Fife. Accident and Health 
Division. North Carolina Department of 
Insurance, 430 N. Salisburv Street. Raleigh. 
North Carolina 27611, or by calling (919) 
733-5060. 

Statutory Authority G.S. 58-9; 58-7 J 2; 58- 
713; 58-^15; 58-7 77. 

TITLE 15 - DEPARTMENT OF 
ENVIRONMENT, HEALTH, AND 

NAIL RAF RESOURCES 



No 



oticc is hereby given in accordance with G.S. 
I SOB- 1 2 that the Environmental Management 
Commission intends to amend rule(s) cited as 15 
XCAC 2B .0303. 

1 he proposed effective date of this action is 
March I. 1990. 



Th 



he public hearing will be conducted at 7:00 
P.M. on November 2, 1989 at Superior Court- 
room. Swain County Courthouse. Mitchell Street, 
Bryson City. NC. 



Cc 



statements, data, and other information may be 
submitted in writing prior to, during, or within 
thirty (30) days after the hearing or may be pre- 
sented orally at the hearing. Oral statements may 
be limited at the discretion of the hearing officer. 
Submittal of written copies of oral statements is 
encouraged. For more information, please contact 
Suzanne 11. Keen, Dhision of Emironmental 
Management, P. O. Box 27687, Raleigh, NC 
27611 - (919) 733-5083. 

CHAPTER 2 - ENVIRONMENTAL 
MANAGEMENT 

SUBCHAPTER 2B - SLRFACE WATER 
STANDARDS: MONITORING 

SECTION .0300 - ASSIGNMENT OF STREAM 
CLASSIFICATIONS 

.0303 LITTLE TENN RIVER BASIN AND 

SAVANNAH RIVER DRAINAGE AREA 

(c) The Fittle Tennesse River Basin and Sa- 
vannah River Drainage Area Schedule of Classi- 
fications and Water Quality Standards was 
amended effective: 



(1) 


Februarv 16, 1977: 


(2) 


March 1, 1977; 


(3) 


Julv 13. 1980; 


<4| 


Februarv 1. 1986; 


(5) 


October 1, 1987; 


(6) 


March 1, 1989; 


Ql 


March 1. 1990. 



(e) The Schedule of Classifications and Water 
Quality Standards for the 1 lttle Tennessee River 
Basin and Savannah River Drainage Area was 
amended effective March _K 1990 hv the reclassi- 
fication of Alarka Creek ( Index No. 2-69) from 
source to Bearmeat Branch including all tnbu- 
tanes from Class C Tr to Class C 1 r ORW. 



omment Procedures: All persons interested in 
this matter are imited to attend. Comments. 



Statutory Authority G.S. 143-214.1; 143-215.1. 
143-215.3(a)(I). 



Ivotice is hereby given in accordance with G.S. 
150B-I2 that the North Carolina Wildlife Re- 
sources Commission intends to amend rule cited 
as 15 NCAC 10B .0209. 

1 he proposed effective date of this action is Fe- 
bruary 1, 1990. 

1 he public hearing will be conducted at 1 ' :00 
p.m. on November 8, 1989 at Surry County 
Courthouse, Dobson, North Carolina. 



(' 



-00 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(comment Procedures: Interested persons may 
present their views either orally or in writing at the 
hearing. In addition, the record of hearing will 
be open for receipt of written comments from Oc- 
tober 24, 1989 to November 28, 1989. Such 
written comments must be delivered or mailed to 
the N.C. Wildlife Commission, 512 N. Salisbury 
Street, Raleigh, NC 2761 1. 

CHAPTER 10 - WILDLIFE RESOURCES AND 
WATER SAFETY 

SUBCHAPTER I0B - HUNTING AND 
TRAPPING 

SECTION .0200 - HUNTING 

.0209 WILD TURKEY (BEARDED 
TURKEYS ONUY) 

(a) Open Season: Second Saturday in April to 
Saturday of the fourth week thereafter on 
bearded turkeys in the following counties: Alle- 
ghany, Ashe, Bertie, Buncombe, Burke, Caswell, 
Cherokee, Clay, Durham, Graham, Granville, 
Hyde, Jackson, Macon, McDowell, Mitchell, 
Onslow, Orange, Person, Rockingham, Scotland, 
Surry, and in the following portions of counties: 
Alamance: All of the county except that part 

south of 1-85 and west of NC 87. 
Anson: That part cast of US 52 and north of 

US 74. 
Bladen: All of the county except that part 
bounded on the west by US 701, on the 
east by 210, and on the south by NC 53, 
SR 1730, and the Columbus County line. 
Brunswick: That part north of US 74-76. 
Caldwell: That part west of US 321. 
Carteret: That part west of US 70 and north 

of NC 24. 
Chatham: That part north and west of US 1. 
Chowan: That part south of US 17. 
Columbus: That part south of US 74 and west 
of NC 410 and that part north of NC 87. 
Craven: That part west of US 70, and south 

ofSR 1100. 
Guilford: That part north of a boundary- 
formed by 1-85 and 1-40. 
I Ialifax: That part north of NC 903 and east 

of 1-95. 
Haywood: That part north of 1-40. 
Henderson: That part west of 1-26. 
Hoke: That part south and west of NC 211. 
Johnston: That part south of US 70 and 1-95 

and east of US 701. 
Jones: That part south of SR 1105 and NC 

58 to Maysville and east of US 1 7. 
Madison: All of the county except that part 
north of NC 208, NC 212 and SR 1434. 



Martin: That part north of a boundary formed 
by US 64 from the Washington County 
line to Williamston, north of NC 125 
from Williamston to the junction with 
NC 142, and north of NC 142 to the Ed- 
gecombe County line. 
Montgomery: That part south of NC 24-27. 
Northampton: That part south of a boundary 
formed by US 158 from the Halifax 
County line to Jackson, NC 305 from 
Jackson to Rich Square, US 258 from 
Rich Square to NC 308, and NC 308 to 
the Bertie County line. 
Pender: That part west of US 421 from the 
Sampson County line to NC 210 and 
south of NC 210 and NC 133 to the New 
Hanover County line. 
Perquimans: That part south of US 17. 
Richmond: That part north of US 74. 
Robeson: That part east of 1-95 and south of 

US 74. 
Swain: All of the county except that part 

south of US 19 and west of NC 28. 
Transylvania: All of the county except that 
part west of US 178, and south of US 64. 
Watauga: That part north of US 421. 
Wilkes: That part north of US 421. 
Yancey: All of the county except that part 
bounded on the west by NC 197, on the 
north by US 19E, and on the east by NC 
80. 
**The Sandhills Game Land in Richmond, 
Scotland, and Moore Counties and the Roanoke 
River Wetlands in Bertie, Halifax, and Martin 
Counties are closed to turkey hunting except by 
holders of special permits authorizing turkey 
hunting. Such permits are issued by authorized 
.representatives of the Wildlife Resources Com- 
mission. 

(b) Bag Uimits: Daily, one; possession, two; 
season, two. 

(c) Dogs Prohibited. It is unlawful to use dogs 
for hunting turkeys. 

(d) Kill Reports. The carcass of each wild 
turkey shall be tagged and the kill reported as 
provided by 15 NCAC 1 0B .0113. 

Statutory Authority G.S. 113-134; 1/3-270.3; 
113-276.1; 1 13-291.2. 

TITLE 21 - OCCUPATIONAL LICENSING 
BOARD 

7V otice is hereby gh'en in accordance with G.S. 
1 SOB- 12 that the Board of Medical Examiners of 
the State of North Carolina intends to amend 
rules cited as 21 NCAC 32 A .0004; 32B .0214, 



NORTH CAROLINA REGISTER 



701 



PROPOSED RULES 



.0309, .0508; adopt rules cited as 21 SCAC 32L 
.0001 - .0002; and repeal rules cited as 21 SCAC 
32B .0205. .0303. 



Th 



he proposed effective date of this action is 
March 1, 1990. 

I he public hearing will be conducted at 8:30 
a.m. on December 1 , I9S9 at Ballroom 2. N. Ra- 
leigh Hilton. 3415 Old Wake Forest Road, Ra- 
leigh, S.C. 



Cc 



omment Procedures: Persons interested may 
present written or oral statements relevant to the 
actions proposed at a hearing to be held as indi- 
cated above. Written statements not presented at 
the hearing should be directed before Sovember 
15, 1989, to the following address: Administrative 
Procedures, S.C. Board of Medical Examiners. 
P.O. Box 26808, Raleigh S C. 27611-6808. 

CHAPTER 32 - BOARD OF MEDICAL 
EXAMINERS 

SUBCHAPTER 32A - ORGANIZATION 

.0004 MEETINGS 

I he Board customarily meets se* ea tkaes a vert* 
h* January. March. May. Juno. August. Octob e r. 
a«4 Ducomhur at rc.jularh scheduled intervals 
as appropnate to earn out Board business. 
Other meetings may be called by the President 
of the Board or upon written request of the ma- 
jority of the members of the Board. 

Statutory Authority G.S. 90-5. 

SI BCII \PTFR 32B I ICENSE TO PRACTICE 
MEDIC INK 

SECTION .0200 - I ICENSE BY WRITTEN 
EXAMINATION 

.0205 CITIZENSHIP (REPEALED) 

Statutory Authority G.S. 90-9. 

.0214 PERSON Al INIERVIEW 

To be eligible for the written examination, ap- 
plicants who are graduates of medical schools not 
approved by the LCMF or AOA a«4 applicants 
who H*e U.S.A. immigrants must appear before 
the Executive Secretary for a personal interview 
upon completion of all credentials. Immigrants 
must present th e ir A lion Registration Receipt 
Cards at- t4*e interview Failure te pr e s e nt tl*» 
*?*f4 constitutes tm incomp l ete - application. This 
interview must be conducted at least 75 days 
prior to the date of the examination. 



Statutory Authority G.S. 90-6. 

SECTION .0300 LICTNSE B\ ENDORSEMENT 

.0303 CITIZENSHIP (REPEALFD) 

Statutory Authority G.S. 90-13. 

.0309 PERSONAL INTERVIEW 

To be eligible for license by endorsement of 
credentials, applicants who are graduates of 
medical schools not approved by the LCME or 
AOA a«4 applicant '. wW af» U S A immigrants 
must appear before the Executive Secretary, a 
Board member, or the full Board for a personal 
interview upon corr.pl tion of all credentials. 
Immigrants must present their iMie - n Registration 
Receipt Curds a* tke interview Failure te pros 
e«t ti*Hr &af4 constitutes a» incomplete upplioa 

Statutory Authority G.S. 90-13. 

SFCTION .0500 - RESIDENT'S TRAINING 
LICENSE 

.0508 MEDICAL EDUCATION 

(*> Applicants for resident's training license 
must have the medical education required bv 
G.S. 90-9. 

( 1) To be eligible for a resident's training license, 
an applicant must have the following med- 
ical education: 

(a) (-ty be a graduate of a medical school ap- 

pioved by either LCMF or AOA; or 

(b) f4f be a graduate of a medical school not 

approved by either i CME or AOA and 
meet the requmment regarding ECFMG 
undei Rule 0507 of this Section. 

(2) fb-) If ,i graduate of a medical school not 
approved by either LCME or AOA has 
taken clinical clerkships in the U.S.A., the 
applicant must: 

(a) f44 meet the requirement regarding 
ECFMG under Rule .0507 of this Sec- 
tion, 

(b) (3) furnish evidence that he has satisfac- 
torily completed clinical clerkships at 
teaching hospitals in the U.S.A. with 
ACGME or AOA approved graduate 
medical education and training programs 
in the areas of the specific clerkships; or 

(c) (4-) if clerkships do not meet the require- 

ment in (b)(2) (2)(b) of this Rule, remedy 
the deficiencies as follows' 
(i) (-A-) re apply to medical school so that the 
school may arrange for the applicant to 



702 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



complete approved clinical clerkships as 

required; or 
(ii) ftt} apply for admission to advanced 

standing at a medical school approved by 

the LCME or AOA to repeat one year of 

clinical clerkship. 
(3) A graduate of a medical school not ap- 
proved bv cither I ('Ml' or AOA whose 
clinical clerkships do not meet the require- 
ments in (2)(b) of this Rule who has satis- 
factorily completed three years of graduate 
medical education and training after gradu- 
ating from a medical school which is ap- 
proved bv the ACGME or AOA, must 
submit proof of the three years of graduate 
medical education and training. 
fe} The burden of proof of medical education is 
on the applicant. 

Statutory Authority G.S. 90-/5. 

SUBCHAPTER 32L - STANDARDS OF 
PRACTICE 

.0001 DEFINITIONS 



The following definitions apply to this Sub- 
chapter: 

(1) "Practitioner" means any person authorized 
to issue prescriptions. 

(2) "Prescription" means an order for medica- 
tion for a patient. 

Statutory Authority G.S. 90-14. 

.0002 PRESCRIPTIONS 

(a) Written prescriptions shall be written with 
ink or indelible pencil or typewritten and shall 
be manually signed by the practitioner at the time 
of issuance. 

(b) No prescription may be issued for a patient 
in the absence of a physician-patient relationship. 
A physician-patient relationship where a pre- 
scription is issued shall include the maintenance 
of a patient record documenting the physical ex- 
amination of the patient by the practitioner and 
the prescription given to the patient. 

(c) No prescription for controlled substances 
or mind-altering chemicals may be issued by a 
practitioner for himself. 

Statutory Authority G.S. 90-14. 



NORTH CAROLINA REGISTER 



703 



FINAL RULES 



TheL 



isl of Rules Codified is a listing of rules that were filed to be effective in the month indicated. 



I\ules filed for publication in the NCAC may not be identical to the proposed text published pre- 
viously in the Register. Please contact this office if you have any questions. 

/\ dopted rules filed by the Departments of Correction, Revenue and Transportation are published 
in this section. These departments are not subject to the provisions ofG.S. I50B, Article 2 requiring 
publication in the X.C. Register of proposed rules. 

LJ pon request from the adopting agency, the text of rules will be published in this section. 

/\ n agency has 30 days from the effect'we date of a rule to notify this agency of any typographical 
or technical errors in the rule as codified. These corrections are incorporated into the List of Rules 
Codified and are noted as * Correction. A typographical or technical error does not change the ef- 
fective date if corrected within the 30 day requirement. 



NORTH CAROLINA ADMINISTRATIVE CODE 

LIST OF RULES CODIFIED 

OCTOBER 1989 



AGENCY 
DEPARTMENT OF AGRICULTURE 



2 NCAC 10G .0301 - .0302 
20B .0413 
43L .0401 - .0403 

.0409 
48A .0805 
.0901 
.1103 
.1201 
48C .0002 

.0004 - .0006 
.0008 - .0009 
.0023 

DKl'AKTMKM OK COMMERCE 

4 NCAC 5C .0103 
DEPARTMENT Oh CORRECTIONS 

5 NCAC 2D .0201 

.0204 
2E .1501 - .1503 

DEPARTMENT OF CULTURAL RESOURCES 

7 NCAC 4U .0001 - .0002 



ACTION TAKEN 



Amended 

Amended 

Amended 

Adopted 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 



Amended 



Amended 
Amended 
Adopted 



Amended 



704 



NORTH CAROLINA REGISTER 



FINAL RULES 



OFFICES OF THE GOVERNOR AND LIEUTENANT GOVERNOR 



NCAC 



10 



NCAC 



2B 


Executive Order Number 95 






TiiT. July 


25, 1989 






Executive Order Number 96 






Eff. July 


25, 1989 




HUMAN RESOURCES 




3H 


.0513 




Amended 




.0514- .( 


)515 


Adopted 




.0517 




Adopted 


7B 


.0337 




Temp. Amended 
Expires 02-28-90 




.0347 




Temp. Amended 
Expires 02-28-90 




.0349 




Temp. Amended 
Expires 02-28-90 




.0351 




Temp. Amended 
Expires 02-28-90 


8F 


.0111 




* Correction 


11 


.0705 




Amended 



DEPARTMENT OF INSURANCE 



11 



NCAC 



12 



.0605 

.0608 - .0609 

.0801 - .0814 



Amended 
Amended 
Temp. Adopted 
Expires 02-26-90 



DEPARTMENT OF JUSTICE 



12 



NCAC 



7D .0401 



Temp. Amended 
Expires 03-31-90 



DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAE RESOURCES 



15 NCAC 2B .0101 

.0103- .0104 
.0106 
.0108 
.0109 

.0201 - .0206 
.0208 

.0211 - .0212 
.0213 

.0215- .0216 
.0218 
.0301 
.0304 
2D .0104 
.0401 
.0404 
.0407 
.0501 
.0511 
.0516 
.0519 



Amended 

Amended 

Amended 

Amended 

Adopted 

Amended 

Amended 

Amended 

Repealed 

Amended 

Adopted 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 



NORTH CAROLINA REGISTER 



705 



FINAL RULES 





.0524 - 


.0525 


Amended 




.0530 - 


.0532 


/Amended 


211 


.0601 




Amended 




.0603 




Amended 




.0606 




Amended 


7H 


.0208 - 


.0209 


Amended 


7K 


.0208 




Amended 


10B 


.0115 




Amended 




.0117 




/Amended 


IOF 


.0347 




Amended 


DEPARTMENT OF TRANSPORTATION 




19A NCAC 3D 


.0216 




Amended 




.0219 




Amended 




.0221 




Amended 




.0222 




Repealed 




.0224 




Repealed 




.0228 




Amended 




.0231 




Amended 




.0515 




Amended 


3J 


.0606 




* Correction 


BOARD OF ARCHITECTED 


K 
.0207 - 


.0209 




21 NCAC 2 


Amended 




.0302 




.Amended 


HOARD OF MFDICAI. EXAMINERS 






21 NCAC 32B 


.0205 


Temp. Repealed 








Expires 03-03-90 




.0214 




Temp. Amended 
Expires 03-03-90 




.0303 




Temp. Repealed 
Expires 03-03-90 




.0309 




Temp. Amended 
Expires 03-03-90 


BOARD OF NURSING 








21 NCAC 36 


.0209 




Amended 




.0211 




/Amended 




.0213 




Amended 




.0217 - 


.0218 


/Amended 




.0223 




Amended 


BOARD OF PHYSICAL THERAPY EXAMINERS 




21 NCAC 48A 


.0005 




Amended 


48B 


.0002 - 


.0003 


Amended 


48C 


.0101 




Amended 


4SD 


.0008 




Amended 


4SE 


0104 




/Amended 




.0110 




Amended 


48 F 


.0002 




.Amended 


48G 


.0203 




Amended 


BOARD OF PI I MBI\G AND HEATING CONTRACTORS 













"06 NORTH CAROLINA REGISTER 



FINAL RULES 



21 NCAC 50 .0505 
BOARD OF PRACTICING PSYCHOLOGISTS 



21 



NCAC 54 .1605 



OFFICE OF STATE PERSONNEL 



25 NCAC 



1A .0004 

IK .0612- .0613 



Amended 



Temp. Amended 
Expires 04-01-90 



Adopted 
Temp. Adopted 
Expires 02-24-90 



NORTH CAROLINA REGISTER 



707 



NC AC INDEX 



TITLE/MAJOR DIVISIONS OF THE NORTH CAROLINA ADMINISTRATIVE CODE 
TITLE DEPARTMENT 

1 Administration, Department of 

2 Agriculture. Department of 

3 Auditor, Department of State 

4 Commerce, Department of 

5 Corrections, Department of 

6 Council of State 

Cultural Resources, Department of 

8 Elections, State Board of 

9 Governor, Office of the 

10 Human Resources, Department of 

1 1 Insurance, Department of 

12 Justice, Department of 

13 I abor, Department of 

14A Crime Control and Public Safety, Department of 

15 Environment, Health, and Natural Resources, Department of 

16 Public Education, Department of 

1 7 Revenue, Department of 

18 Secretary' of State, Department of 
19A Transportation, Department of 
20 Treasurer, Department of State 

*21 Occupational Licensing Boards 

22 Administrative Procedures 

23 Community Colleges, Department of 

24 Independent Agencies 

25 State Personnel, Office of 

26 .Administrative Hearings, Office of 

NOTE: Title 21 contains the chapters of the various occupational licensing boards. 
CHAPTER LICENSING BOARDS 

2 Architecture, Board of 

4 Auctioneers, Commission for 

6 Barber Examiners, Board of 

8 Certified Public Accountant Examiners, Board of 

10 Chiropractic Examiners, Board of 

12 General Contractors, Licensing Board for 

14 Cosmetic Art Examiners, Board of 

16 Dental Examiners, Board of 

18 Electrical Contractors. Board of Examiners of 

20 Eorcsters, Board of Registration for 

21 Geologists, Board of 

22 I Iearing Aid Dealers and Litters Board 
26 Landscape Architects, Licensing Board of 

28 Landscape Contractors, Registration Board of 

31 Martial & Family Therapy Certification Board 

32 Medical Examiners, Board of 

33 Midwifery Joint Committee 

34 Mortuary Science. Board of 

36 Nursing. Board of 

37 Nursing Home Administrators, Board of 

38 Occupational Therapists, Board of 
40 Opticians. Board of 

42 Optometry, Board of Examiners in 



t 



♦ 



♦ 



708 NOR TH CAROLINA REGIS TER 



NC AC INDEX 



44 Osteopathic Examination and Registration, Board of 

46 Pharmacy, Board of 

48 Physical Therapy Examiners, Board of 

50 Plumbing and Heating Contractors, Board of 

52 Podiatry Examiners, Board of 

53 Practicing Counselors, Board of 

54 Practicing Psychologists, Board of 
56 Professional Engineers and Land Surveyors, Board of 
58 Real Estate Commission 
60 Refrigeration Examiners, Board of 

62 Sanitarian Examiners, Board of 

63 Social Work, Certification Board for 

64 Speech and Language Pathologists and 

Audiologists, Board of Examiners of 

66 Veterinary Medical Board 






NOR 77/ CAROLINA REGIS TER 709 



CUMULA TIVE INDEX 



CUMULA TIVE INDEX 

(April 1989 - March 1990) 



t 



1989 - 1990 

Pages Issue 

1 - 151 1- April 

152 - 192 2- ApnJ 

193 - 216 3- May 

217 - 289 4- May 

290 - 311 5- June 

312 - 364 6- June 

365 - 454 7- July 

455 - 477 8- July 

478 - 521 9- August 

522 - 584 10- August 

585 - 616 11- September 

617 - 658 12- September 

659 - 712 13- October 



AO - Administrative Order 

AC] - Attorney General's Opinions 

C - Correction 

FR - Final Rule 

GS - General Statute 

JO - Judicial Orders or Decision 

M - Miscellaneous 

NP - Notice of Petitions 

PR - Proposed Rule 

SO - Statements of Organization 

TR - Temporary Rule 



I 



ADMINISTRATIVE ORDER 

Administrative Order, 4, 152 



AGRICULTURE 

Cotton Warehouse, 



20 PR 



Markets, 217 PR, 546 PR 

N.C. Pesticide Board, 292 PR 

N.C. Plant Conservation Board, 196 PR 

N.C. State Fair, 217 PR 

Plant Industry, 153 PR, 218 PR 



COMMERCE 

Finance Center, 368 PR 

N.C. Cemetery Commission, 198 PR 

N.C. Milk Commission, 455 PR 

COMMUNITY COLLEGES 



♦ 



710 



NORTH CAROLINA REGISTER 



CUMULA TIVE INDEX 



Board of Community Colleges, 352 PR 

CORRECTION 

Division of Prisons, 472 FR, 646 FR 

CRIME CONTROL AND PUBLIC SAFETY 

Victim and Justice Services, 573 PR 

CULTURAL RESOURCES 

Archives and History, 370 PR, 455 PR, 593 PR 

Arts Council, 371 PR 

U.S.S. North Carolina Battleship Commission, 548 PR 

EDUCATION 

Elementary and Secondary Education, 253 PR, 295 PR, 511 PR 

ELECTIONS, STATE BOARD OF 

Departmental Rules, 661 PR 

ENVIRONMENT, HEALTH, AND NATURAL RESOURCES 

Coastal Management, 239 PR, 508 PR, 574 PR 

Community Assistance, 134 PR 

Departmental Rules, 601 PR 

Economic Opportunity, 178 PR 

Environmental Management, 18 PR, 160 PR, 202 PR, 238 PR, 295 PR, 347 PR, 

431 PR, 456 PR, 700 PR 
Governor's Waste Management Board, 617 C 
Marine Fisheries, 47 PR, 457 PR 
Wildlife Resources and Water Safety, 134 PR, 178 PR, 207 PR, 252 PR, 574 PR, 700 PR 

FINAL DECISION LETTERS 

Voting Rights Act, 5, 193, 367, 523, 587, 618, 659 

FINAL RULES 

List of Rules Codified, 183 FR, 274 FR, 303 FR, 445 FR, 515 FR, 609 FR, 704 FR 

GOVERNOR/LT. GOVERNOR 

Executive Orders, 1, 290, 312, 365, 478, 522, 585 

HUMAN RESOURCES 

Departmental Rules, 372 PR 

Facility Services, 199 PR, 377 PR, 594 PR 

Governor's Waste Management Board, 552 PR 

Health Services, 153 PR, 315 PR, 405 PR, 661 PR 

Medical Assistance, 158 PR, 294 PR, 455 PR, 549 PR, 601 PR, 620 PR 

Mental Health: Mental Retardation and Substance Abuse Services, 17 PR, 417 PR, 685 PR 

Social Services, 550 PR 

Vocational Rehabilitation Services, 7 PR 

Water Treatment Facility Operators Board of Certification, 549 PR 

INDEPENDENT AGENCIES 

Housing Finance Agency, 459 PR 

INSURANCE 

Auent Services Division, 561 PR 

Fire and Casualty Division, 202 PR, 479 PR, 689 PR 

Life, Accident and Health Division, 690 PR 

JUSTICE 



NOR 77/ CA ROLINA REGIS TER 71 1 



CUMULA TIVE INDEX 



Criminal Justice Education and Training Standards Commission, 569 PR 

Private Protective Services Board, 621 PR 

Sheriff's Education and Training Standards Division, 491 PR 



f 



LICENSING BOARDS 

Architecture, 349 PR 

CPA Examiners, 458 PR 

General Contractors, 512 PR 

I andscape Architects, 443 PR 

Medical Examiners, 604 PR, 701 PR 

North Carolina Certification Board for Social Work, 179 PR 

Nursing, Board of, 296 PR 

Physical Therapy Examiners, 262 PR 

Practicing Psychologists, 606 PR 

REVENUE 

Sales and Use Tax, 353 PR 

STATE PERSONNEL 

State Personnel Commission, 181 PR, 210 PR, 265 PR, 461 PR, 624 PR 

STATEMENTS OF ORGANIZATION 

Statements of Organization, 524 SO 

TRANSPORTATION 

Division of Motor Vehicles, 140 PR, 607 PR, 648 PR 



I 



♦ 



'12 NORTH CAROLINA REGISTER 



1 



NOW AVAILABLE 



NORTH CAROLINA ADMINISTRATIVE CODE 



The full publication consists of 52 volumes, totaling in excess of 15,000 pages. It is supplemented monthly 
with replacement pages. A one year subscription to the full publication including supplements can be 
purchased for seven hundred and fifty dollars ($750.00). Individual volumes may also be purchased with 
supplement service. Renewal subscriptions for supplements to the initial publication are available at one- 
half the new subscription price. 



PRICE LIST FOR THE SUBSCRIPTION YEAR 











New 


/olumc 


Title 


Chapter 


Subject 


Subscription* 


1 - 52 


Full Code 




All titles 


$750.00 


1 


1 


1 - 37 


Administration 


90.00 


2 


2 


1 -24 


Agriculture 


75.00 


3 


2 


25- 52 


Agriculture 


75.00 


4 


3 


1 -4 


Auditor 


10.00 


5 


4 


1 - 2 


Commerce (includes ABC) 45.00 


6 


4 


3- 17 


Commerce 


90.00 


7 


5 


1 - 2 


Corrections 


60.00 


8 


5 


3- 4 


Corrections 


30.00 


9 


6 


1 - 4 


Council of State 






7 


1 - 11 


Cultural Resources 


60.00 


10 


8 


1 -9 


Elections 


10.00 


11 


9 


1 -4 


Governor 


45.00 


12 


10 


1 - 2 


Human Resources 


30.00 


13 


10 


3A - 3K 


Human Resources 


90.00 


14 


10 


3L- 3R 


Human Resources 
(includes CON) 


45.00 


15 


10 


3S - 3U 


Human Resources 


30.00 


16 


10 


4- 6 


Human Resources 


30.00 


17 


10 


7 


Human Resources 
(includes Brcathalizcr) 


30.00 


18 


10 


8 - 9 


Human Resources 


60.00 


19 


10 


10 


Human Resources 


90.00 


20 


1(1 


11 - 14 


Human Resources 


60.00 


21 


1(1 


15- 17 


Human Resources 


45.00 


22 


10 


18 


Human Resources 


75.00 


23 


10 


19-30 


Human Resources 


90.00 


24 


10 


31 - 33 


Human Resources 


30.00 


25 


10 


34-41 


Human Resources 


60.00 


26 


to 


42 


Human Resources 


45.00 


27 


10 


43- 50 


Human Resources 


90.00 


28 


11 


1 - 15 


Insurance 


90.00 



Quantity 



Total 
Price 



Continued 



Volume Title 



29 


12 


30 


13 


31 


13 


32 


13 


33 


14A 


34 


15 


35 


15 


36 


15 


37 


15 


38 


15 


39 


15 


40 


16 


41 


17 


42 


17 


43 


18 


44 


19A 


4> 


20 


46 


21 


4^ 


21 


48 


21 




22 


49 


23 


50 


24 


51 


25 


52 


26 







New 


Chapter 


Subject 


Subscription* 


1 - 12 


Justice 


90.00 


1 -6 


Labor 


30.00 


7 


OSHA 


45.00 


S - 15 


I abor 


45.00 


1 - 11 


Crime Control and 






Public Safety 


45.00 


1 - 2 


EHNR (includes EMC) 


90.00 


3 - 6 


EHNR 


45.00 


7 


Coastal Management 


45.00 


8 - 9 


EHNR 


30.00 


10 


Wildlife 


45.00 


11-22 


EHNR 


60.00 


1 - 6 


Education 


30.00 


1 - 6 


Revenue 


75.00 


7 - 11 


Revenue 


60.00 


1 - 7 


Secretary of State 


30.00 


1 - 6 


Transportation 


90.00 


1 - 9 


Treasurer 


45.00 


1 - 16 


Licensing Boards 


75.00 


17 - 37 


Licensing Boards 


75.00 


38 - 70 


Licensing Boards 




1 - 2 


Administrative Procedure? 


75.00 


1 - 2 


Community Colleges 


10.00 


1 - 2 


Independent Agencies 


10.00 


1 


State Personnel 


60.00 


1 - 4 


Administrative Hearings 


10.00 



Quantity 



Total 

Price 



♦ 



♦ 



Total 



(Make checks payable to Office of Administrative Hearings.) 

This price includes the title in its current form plus supplementation for the subscription year. 
Subscription years arc January I through December 31. 



MAIL TO: 



OFFICE OF ADMINISTRATIVE HEARINGS 

POST OFFICE DRAWER 11666 

RALEIGH, NORTH CAROLINA 27604 



♦ 



W9LZ ™?10JB3 qyoN 'qSiaiBy 

9991 J J3MBJQ O d 
S8U1JB3H 3AIJBJJSIUIUIPV JO 33IJJO 



aaaH 

dWVIS 
HDVHd 



FOLD HERE 



NORTH CAROLINA REGISTER 
ORDER FORM 



D Please enter my subscription for the North Carolina Register to start with the issue. 

($105.00)/year subscription) 

□ Renew North Carolina Register 

□ Check Enclosed □ Please bill me 

Please make checks payable to Office of Administrative Hearings 

NAME ADDRESS 

CITY STATE ZIP 

PHONE 



(Return to Office of Administrative Hearings - fold at line, staple at bottom and affix postage.) 



CHANGE OF ADDRESS: 



1. Present Address 



NAME 



ADDRESS 



CITY 



2. New Address 



NAME 



ADDRESS 



CITY 



f 



STATE 



ZIP 



. 



STATE 



ZIP 



I 



Office of Administrative Hearings 

P. O. Drawer 11666 
Raleigh, North Carolina 27604 



FIRST CLASS MAIL 



*